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XIM UNIVERSITY

UNDERTAKING BY STUDENTS FOR RETURNING TO THE CAMPUS

I ……………………………………………Roll no:………….,bastudent of
…………………………….(name of the school), XIM University, have carefully read all the
guidelines/advisory issued by the university regarding my r e t u r n / stay in the campus during
the current COVID-19 from September 2021 and hereby undertake the following:

1. I have taken both doses of vaccination and my vaccination certificate is enclosed.

2. I confirm that I have tested myself for Covid-19 (date…) and have tested negative. I am
attaching a copy of the report.

3. Yet, if at all in any unfortunate situation, I get affected with COVID-19 infection, while
returning to or during my stay in the campus, the University will not be responsible for it.
At any point of time if there is a need for quarantine and testing, I shall agree for the same.
My stay in the campus is solely at the discretion of management of the university. I may be
asked to vacate the Campus at any point of time at my own cost.

4. I know that I will not be allowed to leave the campus without prior permission of the hostel
authorities and that too only in case of emergency or extreme necessity.

5. Any violation of the guidelines, students may not be allowed to stay in the campus till the
situation improves

Signature Date: Mobile: Email:

Parental Undertaking:
I, Mr. / Ms. __________________________________________ father / mother / legal guardian of
Mr/Miss _____________________________Roll No. …… do hereby undertake and confirm that
I have carefully read and fully understood the guideline as well as the risk associated of current
Covid-19 condition and giving consent with taking all responsibility as a parent/guardian.

I willingly allow him/her to travel to XIM University campus at Chandrasekharpur, Bhubaneswar


or at Nijigada Kurki, Harirajpur as the case may be.

I declare that in any unfortunate situation, if he/she gets affected with Covid-19 infection, while
returning to the camps or during his/her stay in the campus, the University will not be held
responsible for it.

Signature Date: Mobile: Email:

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