Authorization

I, AKASH ADAK (name of the candidate to be enrolled) s/o, PRAVAS ADAK (Father’s / Mother’s Name)
hereby authorize the Institute authorities to share the details regarding my Attendance / Marks / Grades
obtained / Awards/ Medals received by me / Disciplinary proceedings or actions initiated/ taken upon me, during
the course of my enrollment at IIIT Allahabad with the following:

Sl. Name of the Person Relationship Contact Address Contact Email (Contact
No. Authorized with the Student Phone Number)

1. PRAVAS ADAK FATHER 224-A/1, Street No 5, New pravasadak3@gmail.com

Lahore Ext. Shastri Nagar, (9350490051)
Delhi 31
2. KALPANA ADAK MOTHER 224-A/1, Street No 5, New kalpanaadak003@gmail.com
Lahore Ext. Shastri Nagar, (9643474050)
Delhi 31
3. PRITIKANA ADAK SISTER 224-A/1, Street No 5, New 7703832856
Lahore Ext. Shastri Nagar,
Delhi 31

I, AKASH ADAK (name of the candidate to be enrolled) s/o, PRAVAS ADAK (Father’s / Mother’s Name)
hereby also authorise the Institute to share such other details with the person(s) above named, as may be felt
necessary and proper by the Institute, towards my overall Conduct / Grooming and Personality as a
responsible professional / citizen of the country, during the course of my enrollment at the Institute.

Candidate Signature - …………………………………………………………..

Candidate Name – ………………………………………………………………

Certified that the details as above, presented by the Candidate, are correct and acceptable to

me. Candidate’s Father’s / Mother’s / Guardian’s Signature:……………………………….

Candidate’s Father’s / Mother’s / Guardian’s Name:……………………………….

Date :………………

Place :……………..