MINORITY COMMUNITY STUDENT’S

SELF DECLARATION
For Admission under Minority Quota
Std.11th Centralised Online Admission Process

Application Form No: - ----------------------------------------------------------- City :- -----------------------------------------------

I, --------------------------------------------------------------------------------------------------------------------------------- (Student’s Name)

hereby declare that
As my mother tongue is not mentioned in my Leaving/Transfer Certificate for
deciding my candidature under linguistic minority status. I undertake that my mother
tongue is -------------------------------------- . so
I belong to LINGUISTIC MINORITY community.
*(Bengali/Gujarati/Hindi/Konkani/Marwadi/Odiya/Punjabi/Sindhi/Kannada/Malayalam/Tamil/Telugu/Urdu/SouthIndi)

AND / OR
As my religion is not mentioned in my Leaving/Transfer Certificate for
deciding my candidature under religious minority status. I undertake that my religious
community is -------------------------------------- . so
I belong to the RELIGIOUS MINORITY community.
*Buddhist /Christian /Jain /Muslim /Zoroastrian(Parsi) /Sikh

I undertake to submit the relevant documents supporting my claim for

belonging to minority community as per government resolution Minority Department
No.AVV-2010C.No109/10Desk-5,Dated.01/07/2013 at the time admission
( *Strike out whichever is not applicable)

Date- / /20
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Student’s Signature and Name Parent’s Signature and Name
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