APPLICATION FOR CONFIRMATION OF ELIGIBILITY AND PROVISIONAL ADM! FOR THE ACADEMIC YEAR: 2022-2023 Te ‘The Registrar ‘Symbiosis Intemational (Deemed University) Gram: Lavale, Tal: Mulshi, Pune-412 115 ‘Through The Director ‘Symbiosis Institute of International Business G. No, 174/1 Hinjewadi, Taluka - Mulshi, Pune - 411057 |, DAIDA CHAKRADHAR , age 24 yrs., son/ daughter of DAIDA SAIDIAH & DAIDA KAVITHA, resident of H.NO 7-101, OPP CENTENARY BAPTIST CHURCH, VEMULAPALLI, NALGONDA, Telangana - 508217 seeking provisional admission for the academic year 2022-23 in Master of Business Administration (Agri Business) programme at ‘Symbiosis Institute of International Business (hereinafter referred to as Constituent), which is @ Constituent of ‘Symbiosis International (Deemed University), Pune (hereinafter referred to as SIU), do hereby solemnly affirm, state and declare as under: = 1] THAT, MY ADMISSION IS PROVISIONAL AND SUBJECT TO FULFILLMENT OF ALL THE ELIGIBILITY CONDITIONS, AS LAID DOWN IN THE ELIGIBILITY RULES OF THE SYMBIOSIS INTERNATIONAL (DEEMED UNIVERSITY) (SIU) FOR THE PROGRAMME TO WHICH | HAVE BEEN PROVISIONALLY ADMITTED. | ALSOUNDERSTAND THAT NO CAPITATION FEE/ DONATION IS CHARGED FOR ADMISSION TO ANY PROGRAMME AT ANY CONSTITUENT OF SYMBIOSIS INTERNATIONAL (DEEMED UNIVERSITY). | UNDERTAKE TO PAY ALL MY FEES TO SYMBIOSIS THROUGH BANKING CHANNELS AND NOT IN CASH. Page 1 of 62] THAT, | have furnished the true facts in the online application for entrance test! selection process (group exercise/ Personal interaction! writing ability test/ studio test)’ admission’ finance! examination and shall abide by the Rules(s) Guidelines(s)/ Process(s) prescribed and as amended time to time therein. 3] THAT, the admission is being offered to me on the basis of information furnished and documents submitted by me. 4] THAT, SIU may cancel my admission at any stage/ time, if itis revealed that admission has been secured by using fraudulent means or in case of any information or particulars found wrong! false or any fact concealed and | shall have no laim what-so-ever with respect to my admission at any point of time. | understand the SIU/ Constituent may change or reverse any other decision made on the basis of incorrect or incomplete information submitted by me. '5] THAT, I have gone through the admission and eligibility rules of the University for the Master of Business ‘Administration (Agri Business) Programme; and that, | also have read carefully the applicable eligibilty eriteria for the said Programme which is as below: Graduate from any recognized University/ Institution of National Importance with a minimum of 50% marks or equivalent grade (45% for SC/ ST or equivalent grade). 6] THAT, | shall NOT be eligible for admission to Master of Business Administration (Agri Business) Programme unless | successfully complete 3/4/5 years of an undergraduate degree and/ or earned prescribed number of credits for ‘an undergraduate degree, through the examinations conducted by a University/ Autonomous Institution or possesses ‘such qualifications as recognised by the concerned University as equivalent to an undergraduate degree. 7) THAT, | am required to submit following documents for scrutiny of eligibility and confirmation of provisional admission in ‘originals for verification and have also noted the last date to produce applicable documents in originall sel-attested photocopy: () Xilth Standard! Diploma Mark List” ) Statement of Marks of all Semesters/Trimesters/ Years of Qualifying Examination* (il) Migration Certificate issued by last attended University! Institution in original” (iv) Transferenca/ Leaving Certificate issued by last attonded Institute/ University in original* {(v) Passing Certificate! Provisional Degree/ Degree Certificate” (i) Caste Certificate" (vii) Category Certificate #* (vill) Domicile Certificate #* (ix) Gap Certificate (break before or after college/ university during which students engage in various educational and developmental activities, such as travel or some type of regular work) #* (%) Experience Certificate #* (xi) Registration Certificate (wherever required by respective council#* (xi) Bonafide Certificate (if applicable)# (xi) Certificate of Change in Name issued by Appropriate Authorityit (xiv) English Test (xv) Passport (Only for International Students)* (xvi) PIO Card (Only for international Students)" (xvii) OCI Card (Only for International Students)" (vii) Nepal! Bhutan Citizenship Card #* (xix) Visa! Residential Permit #* Page 2 of 6(2x) Equivalence of qualification issued by recognized body! authority (bal) AADHAR Carat (xi) Photo Identity Proof (Driving License / PAN Card! Passport or any other such document as proof of identity issued by Govt, Authority (oi) Entrance Test Admit Card (If applicablo}# (xxiv) Entrance Test Score Card (If applicable) (000) Selection Process (GEIPL-WAT) Admit Card (f applicablo}# (xxvi) Anti-Ragging Affidavit (Student)* (oxvi) Ant-Ragaing Affidavit (Parent)* (wo) Indemnification! Healthcare, Recreation and Sports Undertaking (Student)* (bx) indomnifation! Healthcare, Recreation and Sports Undertaking (Paront)* (xx) Medial Undertaking* (¢ Mandatory) (# if applicable) 7.4 THAT, | am required to produce all the original documents for scrutiny and verification on the day of commencement of the programme. 7.2 THAT, | will apply to the concemed University/ Board! Institute immediately, if | do not produce any of the above document(s). | shall submit the pending document(s) by the given due date. 7.3 THAT, falling to produce above mentioned documents and obtain Eligibility Certificate in the stipulated time, | will not be permitted to appear first and or subsequent semester! annual examination(s) and authorise the University/ Constituent to cancel my admission. £8] THAT, the facts mentioned below are correct and complete: {a) Academic Qualifications:- Qualification Mode of Education Board! University Year of Passing Percentage! Grade (Regular! Distance) XII Standard Diploma 26.9 Bachelor Degree Acharya N.G. Ranga (if applicable) Agricultural University Master Degree (if applicable) Pre Doctoral Degree (f applicabley (Meri) (b) Work Experience (if applicable) Designation Organization Period Work Experience Organization (in months) contact details, From To (Email ID, Phone No. ete.) Page 3 of 69] THAT, | authorise the University! Constituent to confirm facts submitted and documents produced by me from previously attended School! College/ University! Institute or from any other appropriate body! authority, 10] THAT, | am aware of the rules, procedures and requirements of the eligibility process and agree to abide by the decision related to my eligibily. | shall fulfil the eligibility criteria set by the University! Constituent for the programme | have applied for. 11] THAT, | have carefully read and understood the details given in the prospectus and noted the rules, the process of admission and the rules pertaining to refund of fees as given in the prospectus and shall in matter of interpretation accept the decision given by the Registrar of SIU Director of the Constituent in every respect as final and binding. | am well aware of the Non Refundable component of fees. If | cancel my admission, | will give notice to the Constituent well in advance and abide by the process laid down by SIU. 12] THAT, | agree to pay the fees regularly as per the schedule informed to me. | agree that a fine of Rs.100/- per day will be applicable after the due date of payment of academic! hostel/ mess fees. In case of non-payment of fees by the due date, | shall accept any decision/ action taken by the University including cancellation of admission. 13] THAT, SIU/ Constituent has got the right to cancel my admission in case of situations like, Nonssubmission of eligibility documents in stipulated time, Non-Payment of fees for more than one semester and! or Non-reporting to the Constituent for more than 30 days, without prior intimation in writing to the concer authority 414] THAT, | shall take note of all communication sent to me by post! courier! email’ Institute LMS/ uploaded on the wabsite of the University! Insitute and! or affixed on the Notice Board of the Institute’ Hostel [as applicable from time to time] and follow the same and act accordingly. | understand SIU/ Symbiosis Institute of International Business will not be responsible for delays of any kind due to reasons beyond its control 415] THAT, if there is any change in facts submitted by me prior/ during! after studentship, | agree to inform the Constituent! Department/ University as soon as possible. 16] THAT, Iam not pursuing any other degree programme from this University or any other University/ Institution in regular! distance! online mode simultaneously, and if | am found pursuing the samo, it will be subjected to the rules of University Grants Commission and/ or the concerned Statutory Body and violation if any in this regard will be under the disciplinary action. 47] THAT, | should have minimum mandated attendance in theory and practical classes (if applicable for the programme) of the semester to be eligible to appear for examinations and or placements (if applicable). | understand that, in this regard, if my attendance is less than 75%, | willbe given a TNG (Term Not Granted) or CNG (Course Not Granted) as the case may be 18] THAT, upto a maximum of 25% leave of absence (on medical grounds, Institute related work, personal leave requirements or any emergencies) from lectures is permissible with or without prior sanction of the Director. 19] THAT, | am expected to attend and/ or participate in all the curricular! co-curricular! extra-curricular sessions! activities, seminars, conferences & quest lectures which are considered for summer! final placement. 20] THAT, all orientation programmes! camps! seminars/ meets! workshops! gym etc. are essential and significant for me, therefore, | am expected to attend the same as per schedule given. | shall take note of all communication sent to me from SSIU/ Symbiosis Institute of International Business and follow the same from time to time, 21] THAT, Ihave read and understood Examination Rules of the University and Section III-10 regarding resorting to unfair means during examinations and Section Ill-1-1C regarding validity of terms of the Master of Business Administration (Agri Business) and shall abide by the same. 22] THAT, | am aware, if | do not pay the academic fees for the Semester! Year, | wil not be permitted to register and ‘appear for Term End Examinations and my result will not be declared, Page 4 of 623] THAT, | agree to pay the revised fees as per the University rules with respect to examination fess (backlog fees! revaluation fees! practical fees! late fees/ super late fees as applicable), convocation fees, transcript fees, attestation fees, fees for issuing of duplicate documents (degree! diploma certificate! grade sheet statement af marks, consolidated grade sheet/ consolidated statement of marks/ passing certificate hal ticket et.) review of answer script postal courier charges, if any, ot. 24] THAT, | am aware, ance the admission process is over for the respective programme, the inter institute transfer is not permitted for any reason(s) whatsoever. 25] THAT, | will NOT involve myself directly or indirectly in any kind of RAGGING activities inside or outside Symbiosis Institute of International Business campus. | am fully aware that | will be liable for action under relevant penal law! ragging law in case | am found to be a part of any ragging activity. 26] THAT, Ihave read the hostel rules and undertake to abide by the same [as | am availing hostel accommodation}. If | fail to do so, the University! Constituent has the right to take action as per rules and regulations and code of conduct of SSIU/ Symbiosis Institute of International Business. 27] THAT, | will not indulge in any action of using technology and/ or social media causing disrepute to institution’ students, hurting sentiments of other students, abusive in nature, abusing, amounting to racial discrimination or moral turpitude or any such effort which is prohibited under any law in India; and if | am found indulging in such acts, | will be liable for strict disciplinary action which may lead to termination of my admission. | further undertake that | will not indulge in any act of indiscipline or /and misconduct; and if | am found to be involved in any act of indiscipline or misconduct, | am aware that | shall face the consequences for the same; and | am also aware that if fine is imposed for the act of indisciptine or/and misconduct, the amount will be recovered from the security deposit for any misconduct. 28] THAT, during the course of my studentship at Symbiosis, | would not carry! possess/ consume alcohol or any drug that is banned/ prohibited or directly or indirectly, ald & abet consumption or possession or delivery of such alcohol or drug on campus, and I would not enter Symbiosis Campus under influence of alcohol or any prohibited substance. 29] THAT, | vill not indulge in any act of indiscipline; and if | found to be involved in any act of indiscipline or misconduct, 1 shall face the consequences for the same in accordance with the Symbiosis Intemational (Deemed University) [Code of Conduct, Procedure to inquire and decide with Misconducts/ Indiscipline by students] Rules, 2019 and amended from time to time. 30] THAT, | shall NOT be eligible for the award of the Master of Business Administration (Agri Business) degree unless | have successfully completed the programme with minimum requirements prescribed for the award of degree. 31] THAT, | shall! have read and understand! understood the Rules(s)/ Guidelines(s)’ Process(s)/ Code of Conduct governing curricularico-curricular! extra-curricular activities as prescribed by the University and its Constituent’ Department Sponsoring Sociely, and amendment(s) therein from time to time, and shall undertake to abide by them; 32] THAT, the above information is correct and complete in all respects. THAT if any of the information is found to be false, concealed, incomplete, misleading and/ or that | fail to disclose all the information and/ or suppress any information andi or misrepresent the information, the University shall be free to take any action, including withdrawal of my provisional admission at any stage/ time andi or any other action as deemed fit against me according to the law of judicature 33] THAT, if there is any change in the information furnished, | shall intimate the University! Constituent from time to time, 34] THAT, ALL THE DISPUTES WILL BE SUBJECT TO EXCLUSIVE JURISDICTION OF PUNE, MAHARASHTRA, INDIA ONLY. Page 5 of 6Name of Applicant : DAIDA CHAKRADHAR Category : Scheduled Caste ‘SNAP ID : 22012665 GE-PIWAT ID : 24MAB0406 NAD ID PRNo : 22020242070 Batch : 2022-2024 Programme : Master of Business Administration (Agri Business) Name of Constituent ; Symbiosis Institute of Intemational Business Mother's First Name : DAIDA KAVITHA, Father's First Name : DAIDA SAIDIAH Contact No. Contact No. Permanent address (Signature of the Applicant) Name : DAIDA CHAKRADHAR Dated : 21-Jul-2022 Deponent Signature of Witness (Signature ofthe Parent(s)iGuardian(s)) Name Dated ‘Solemnly affirmed and signed before me by the Deponent and witness/parent(s)/guardian(s) on this- day of _| my office, VERIFIED BEFORE ME Notary Public /20__ Page 6 of 6