FORM NO.

F / IIPC / 011
Rev.00 Date 20.03.2020
Page 1 of 2

Field Project , Study Tour & Industrial visit application Form

Academic Year : Year – Year , ODD / EVEN - (Month, year – Month, year )

Date :
Ref. No. -

Course/Dept.(s) Year/ Total Strength No. of Students Date(s) of

(In case of Semester/Sec Visiting Visit / Duration
Interdisciplinary)

Industry Details:
Name of the Industry Contact Person in Industry Address / Contact Number of
Industry

Curriculum Relevance :
( Linked Subject / PO /PSO /CO)

Faculty Details:
Accompanying Staff Designation Contact Number

Transport Details:
Mode of Transport Name of the Travel agency and Address
( Enclose Transport Form)

By Bus / Train

Check List:
S.No Documents to be enclosed Coordinator Verification Remarks & Signature
of Coordinator
1. Industries to be visited and respective
permissions
2. List of Student with Signatures
3. Complete itinerary
4. Boarding & Lodging Reservation details
5. Parent’s Declaration Form

In-charge Dept. Head Dean

 FORM NO. F / IIPC / 011
Rev.00 Date 20.03.2020
Page 2 of 2

Letter of Undertaking for Industrial Tour by Parents and Student.

Date:

To,

The Registrar
Dr.M.G.R. Educational and Research Institute,
Maduravoyal,Chennai-600095.
Subject: Submission of “Industrial Tour Undertaking”- Reg

Dear Sir,

Sub: Industrial Tour to ____________________________ from -______________ to

We, Mr / Mrs.____________________________________parents of
Studying in semester of Dept. of your University, hereby
voluntarily submitting the undertaking. We are aware that our son/ daughter is participating
in the said industrial tour organized by the institute scheduled from______________ to
_____ with our full acceptance. We shall ensure that our son/ daughter
shall abide by the University rules and regulations and shall obey the instructions of the
faculty members who are accompanying the industrial tour / Educational tour.

We also declare and confirm that the University will not be held responsible in the event of
any misfortune/ accident/ personal injuries involving our son/ daughter and take full
responsibility of any damage to the property or accident/ personal injuries to the other
person as a result of our son/daughter’s negligent act during the period of the tour.

Your’s Truly

Father’s/ mother’s Sign Student’s Sign

Mobile No Mobile No
Parent's ID Proof (enclose the copy of Adhar card / Driving License etc.,)