gervitwr Rs.

100
ONE
100 HUNDRED RUPEES
1AAN
O
AR
S.M.H.ZAIDI
SMHZAIDI Mumbei Thané Dist
Mumbai Thane DiSL Reg No 3640
Rag Nu 3649 My C o m m i s s i e n

ENOFARIA NOTARIAL
ATARIAL tARA NORAL 25 Sept 200
St226O/
OF
HETRT MAHARASHTRA 2022 O 19AA 571206

.g.fa.w. oooo28
30 JUN 202
vHZAD
ha

Comr ss 91
ft. f. 7. Ta

DF DEED OF UNDERTAK ING

I, Mz. PRAKASH Son of RANJET MANDAL aged 13 ye ars,

Occupation Student , Education - Std.XIIth, Residing at 151,

Gane sh Mur thy Nagar, Colaba, Mumbai-400 005, do

hereby given an undertaking as foll ows

1.That I have passed Std. XIIth Ex ami na tion

in the year March,a 021 (2021) from /thr ough
HARYANA SHAKTI SR SEC. SCH KANJHAWALA, DELHI

---2--
ARY
MHZATD
3 Thane
ELPH INSTONE
b e i8
That l am desires to take admission in Std. XI/XIl in Jr. College (Name of the Jr. College)
COLLEGE, MMBALforthe Academic Year 2022-2023.

3) That while taking admission, I am required to furnish following documents.

i) Statement of Marks of the last public Examination/Statement of marks of std, Xth,XlIth Examination
of the Junior College (Home Exam)
LAR Passing Certificate of the last public Examination.
School leaving Certificate/Transfer Certificate in Original.
S .
g Ne3Dist
M H
7 A I D I

Migration Certificate in Original

yCTnission
3643

u m u a

(Note: Delete if not applicable)

2 0 2 6
Report ofverification (Pvt. Student only)
e

That I am also aware that my admission, is provisional and that the Jr. College shall have every right to
assesses independently, the truthfulness and correctness of the documents mentioned at Serial Number
(3) of this undertaking That in the event, if it is subsequently found out by the Jr. College/Board that the
particulars furnished in the admission form or the documents furnished while seeking admission are false
and fabricated, in that event Jr. College authoities will have
right to take action me, against including right
to cancel the admission.

5) Iam also fully aware of the fact that the Jr. College has given me provisional admission subject to grant of
eligiblity certificate by the Mumbai Divisional Board, Vashi, Navi Mumbai - 400 703 of Maharashtra State
Board of Secondary and Higher Secondary Education having its Head Office situated at Bhamburda
Shivajinagar, Pune -411 004

6) In case if the Divisional Board rejects my application, submitted through the Head of the Jr. College for
grant of Eligibility Certificate, my admission to the Jr. College shall stand automatically cancelled.

7) In case if the Divisional Board grands me Eligibility Certificate with instructions to furnish certain
documents within stipulated period, I here by undertake to fulfill the requirementwithin the stipulated time
limit.

8) lamaware of the fact that, in case, if I fail to furnish the required documents within the stipulated time Ishall
not be
eligible for admission in the Jr. College and as such my admission shall stand
cancelled.
automatically

That I have read the contents of the undertaking and has properly understood the same and in witness whereof
had signed on this Deed of Undertaking on this day of.. MLY..202.2.. at (Place)
Mumbai.

R a n j e t Mandol
Pckae
(Signature of Guardian or Local Guardian) (Signature and name of the student)

NO
AR SMH ZAIDI
Mumte
Mumtiai ) Diat
& Thane
Mommissin
BEFORE ME
NOTARY
Government ct ndia
Mumbai & Thana Dist

20 JUL ZUZZ