Undertaking from Parents

Date:

I confirm that I am aware about the potential hazards of any process industries and my Son /
Daughter Mr./Ms. ___________________________________will be solely responsible for all risks
that may rise due to his/her negligence, accident, natural calamity etc. during training / internship
period at site or travelling to site. The institute/industry will not be responsible for any liabilities
(Financial and other) during his/her training period.

I will not raise any claim for compensation in view of any accident/natural calamity.

I declare that my son/daughter is solely responsible for his/her own actions and that if any of the
above happens, I will not pursue any legal action against the Institute/Industry.

I declare that my son/daughter is medically fit and does not suffer from any ailments or disease.

Thanking You

Yours Faithfully,

Name of Parent: ______________________________

Relation : _______________________________

Signature : _______________________________

Permanent Address & Contact No.:

________________________________________________________________________________
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________________________________________________________________________________
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Date : _______________

Place : _______________