DECLARATION AND UNDERTAKING

I, Sri/Smt. …………………………………………………………………………….…… a student

of……………………………………………………………..…………………. (Department, Year),
bearing Institute Roll No. ………………………. of NIT, AP during the session 20…………. , do
hereby solemnly declare that I will strictly adhere to the rules and regulation for grant of scholarship
and undertake that:
1. I am not in receipt of any other scholarship/stipend/ financial assistance, etc. from any other
sources.

Signature of Student

2. The documents provided by me are correct and in the event of those being found to be forged
or if I violate the terms and conditions of the Scholarship, the Scholarship sanctioned to me,
may be cancelled and the entire amount of scholarship will be refunded by me or recovered
from me, apart from liability for such penal action as warranted by law or Institute Authority
and Ministry.

Signature of Guardian Signature of Student

3. The Caste certificate and Income certificate are duly verified from original.

Signature of Student

Signature in full:……………………………………………………

Name (in Block letter):……………………………………………..

Please affix a recent
photograph Roll No.:……………………………………………………………

Name of the Department……………………………………………