PSG COLLEGE OF TECHNOLOGY, COIMBATORE – 641004

DEPARTMENT OF PRODUCTION ENGINEERING

DECLARATION FORM
(To be signed by the Student)

I, _____________________________________ (Name & Roll number of the

student), son/daughter of Mr/Ms _____________________________________ hereby
declare that, I am willing to participate in the one day Industrial visit to PSG Foundry which
is situated at Neelambur ( ).
I assure that, I will behave to the best of my standards and keep up the name of the
Institution that i am representing. In case of any mishappenings, it will be solely my
responsibility and not the Institution or the organizers.
I understand that violation of the guidelines shall lead to disciplinary action against me.

Name :
Roll No. :
Mobile No. :
Hosteller : Yes/No
If Hosteller, Room No. :
Signature of the student

DECLARATION FORM
(To be signed by the Parent)

I, ______________________________________________ father/mother/Guardian
of Mr/Ms __________________________________________(Name of the student) am
willingly sending my son/daughter to the one day Industrial visit to PSG Foundry which is
situated at Neelambur ( ).
I assure that he/she will abide by all the rules and regulations of the Industry and
he/she will be solely responsible for his/her actions during the Industrial Visit.

Date:

Place:

Signature of the Parent/Guardian