CRGIRI

IRAuRD
EIH T Rs.20
5.20 TWENTY
INDIA
RUPEES
20INDIA NON JUDicIAL
25 APR 2022
5LOppT6 aHTS TAMIL NADU
G.5.ShaKthivel
019324
R.ashBo
PAdopSnir ipumomunem
LC.No.2vNB/2021
sumsuxbumg. gulgs6
ANNEXURE-I
AFFIDAVIT BY THE STUDENT
1.
I, SHAKTHIVEL.G.S, register No.21BCA0124 (full name of student with
admission/ registration/enrolment number) S/o. Mr. GAJENDIRAN.U, having been
admitted to VIT UNIVERSITY, VELLORE, Name of the institution) have received a
copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational
Institutions, 2009 (hereinafter called the "Regulations") carefully read and fully
understood the provisions contained in the said Regulations.
2) I have, in particular, perused clause 3 of the Regulations and am aware as to what

constitutes ragging
I have also, in particular, perused clause 7 and clause 9.1 ofthe Regulations and am
13)
fully aware of the penal and administrative action that is liable to be taken against
me in case I am found guilty of or abetting ragging, actively or passively, or being
3OSE

B.SC part of a conspiracy to promote ragging

wOTR PUBLDlST
TPT
s
Rnp.
GOMS . No 20970
Ve. A. ARIA AUEPH, 0.Se, BL
For.
ADVOCATE&NOTARY PUBLIC
Opp. Sivajl Theatre
VANIYAMBADI, Vellore Dist
AbvoC Cell: 9443007509
 -2-

A) I hereby solemnly aver and undertake that

a) I will not indulge in any behavior or act that may be constituted as ragging
under clause 3 of the Regulations.

b) IWill not participate in or abet or propagate through any act of commission

or omission that may be constituted as ragging under clause 3 of the

Regulations.
5) I hereby affirm that, if found guilty of ragging, I am liable for punishment
to other criminal
according to clause 9.1 of the Regulations, without prejudice any
action that may be taken against me under any penal law or any law for the time
being in force.

debarred from admission in any

I herebydeclare that I have not been expelled or
found guilty of, abetting or being part
institution in the country on account of being declaration
and further affirm that, in case the
of a conspiracy to promote, ragging;
admission is liable to be cancelled.
is found to be untrue, am aware that my

Declared this 25h day of April month of 2022 year

Signature of Deponent

Name: SHAKTHIVEL.G.S

VERIFICATION:
are true to the best of my knowledge and no part
contents of this affidavit
Verified that the
been concealed or misstated
therein.
affidavit is false and nothing has
of the

on this the 25 (day), of April (month), 2022 (vear)

Verified at Vaniyambadi (place)

Signature of Deponent

and signed in my presence

on this the
25 (day) of April (month) 2022
Solemnly affirmed
contents of this affidavit
the
(year) after reading

vn
oSEPPOr

THTSOMMSSIONER /APMACANËAND NÖtARSCRUNLIC

C sly
ADVOCATE &NOTARY PUBLIC
Opp. Sivaji Theatre
N O TR YP U B L I C

DIST|
TPT
Vir. Rnp. 209/20 VANIYAMBADI, Vellore Dist.
For. M.S.No.
G.0. Cell: 9443007509
DvoC
OCAT

esont
 CIRsiRI RAURID
SI bup Rs.20
5.20 TWENTY
RUPEES
INDIAA
INDIA NON JUDICIAL
5 BT6 iTETAMIL NADU
Ga. 5. Shakbhivel
014G,0724
25 APR 20R2 PAibpnn chipunemuner
L.C.No.2/NNB/2021
ounofusioumg. gibipB
ANNEXURE-II
AFFIDAVIT BY THE PARENT/GUARDIAN
1. Ms. SHANTHIMANI.K.G (full name of Parent/guardian) father/mother/guardian of

SHAKTHIVELG.S, register No.21 BCA0124, have been admitted to VIT

UNIVERSITY, VELLORE, have received a copy of the UGC Regulations on Curbing
the Menace of Ragging in Higher Educational Institutions, 2009 (hereinafter called the

understood the provisions contained in the said

Regulations") carefully read and fully
Regulations.
I have, in particular, perused clause 3 of the Regulations and am aware as to what
2)
constitutes ragging
I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am
3)
fully aware of the penal and administrative action that is liable to be taken against
me in case he/she found guilty of or abetting ragging, actively or passively, or

SEPA being part of a conspiracy to promote ragging.

H O T RP U B L C

A.MARIAJOSEPH, B.sc., B.L

PUBLIC
ADVOCATE & NOTARY
Opp. Sivaji Theatre
VANIYAMBADI, Vellore Dist.
4Dyo Coll: 9442007509
 2
4) I hereby solemnly aver and undertake that
as
a) My ward will not behavior
indulge in any or act that may be constituted
ragging under clause 3 of the Regulations.
through any act of
b) ward will not participate in or abet or propagate under clause 3
COmmission or omission that may be constituted ragging
as

of the Regulations.
T hereby affirm that, if found guilty of ragging, my ward is liable for punishment,
5)
according to clause 9.1 of the Regulations, without prejudice to any other criminal
time
action that may be taken against my under any penal law or any law for the

being in force.
T hereby declare that my ward has not been expelled or debarred from admission in
6)
any institution in the country on account of being found guilty of, abetting or being
affirm that, in case the
part of a promote, ragging; and further
conspiracy to
ward is liable to be
declaration is found to be untrue, the admission of my

cancelled.

Declared this 25 day of April month of 2022 year

Signature of Deponent
Name SHANTHIMANI.K.G
Address: No.420, Anna Swamy Nattar Street,
Amburpet, Vaniyambadi - 635 751,

Tirupattur Dt., Tamilnadu

Mobile No.: 9655553990

VERIFICATION
this affidavit are true to the best of my knowledge and no part
Verified that the contents of
has been concealed or misstated therein.
of the affidavit is false and nothing
this the 25 (day), of April (month), 2022 (year)
Verified at Vaniyambadi (place) on

Signature of Deponent

Solemnly affirmed and signed

in my presence on this the
25 (day) of April (month) 2022
contents of this affidavit.
(year) after reading the
We s
SEPH MARIA ROPkeete
ADVOCATENEAAYPRR

NOTE
R YP U B L I G Opp. Sivaji Theatre
TPT
DIT VANIYAMBADI, Vellore Dist.
Vir.Fhp.
G.0.MS Ho.20920
For. Cell:9443007509

OCAT
ADV
 CERTIFICATE OF PHYSICAL FITNESS

PERSONAL DETAILS

Name

Gender
CShakthivel
Yl
Date of Birth

Blood Grouping
131:2003 Age (in years)

ldentification Marks

History of Allergy if any

ABlaule hnale in palnof hand
History of iviedicai iiness if any

History of Hospitalization / previous Surgery if any

History of Current Medication for any illness

Vaccinate now for Chicken Pox:

Hepatitis A:

Hepatitis B
Typhoid:

TT:

Cholera:

Others if any:

Page 1
 CERTIFICATE OFPHYSICAL FITNESS
NAME OF TNE CANDIDATE:

Pulse /Min Height 73 Cms

BP
lio7o Mm/ Hg Weight K
Bodily Infimity BMI
NA ohe
Communicable Disease Build
wel
Pallor lcterus Clubbing Cyanosis|Lymphadenopathy Oedema

Tonsils Glands Teeth

Normal
CVS Heart Sounds Murmurs
ho mYm
RS
BreathSounds B VeGinor yalh Added Sounds
GIS Liver Spleen Any
NbE Palpebla Mass
CNS Cranial Nerves Motor System Sensory
ota NUme System ntact
G.U.S(Male) Hydrocele Piles Phymosis
G.U.S(Female) Menstrual History

Skin
Nanmal
Hearing Vision (NV/DV) Colour Vision
Mm
Normal/Corrected (Power)
Other Findings/ remarks
f any

(Signature of the candidate) (Signature of the Parent)

I do hereby certifythat 1/ We have examined Mr. /Ms. GS ShakTkive

candidatefor student under VIT University, LLLCampus and whose signature is given above, and cannot
discover that he / she has any disease, communicable, otherwise or constitutional affection or bodily infirmity except
that his/ her weight isimexcessof /belew-the standard prescribed or except

I also certify that he /sinsrhas been vaccinated and had booster against Hepatitis A, B, TT, Typhoid, Chicken pox&
Measles

Name ofthe Doctor DR NETH

Signature of the Doctor

Designation
Date&Place
Asst Sdçon 25 2
Vanitambhe
Seal with Reg.No. Medicin)
t cSugeeT eciakst)
Gor. General hospitalx
Vanlyambadi, Velore Dst635 751.