Appendix IV

Declaration by the Candidate for Gap in Education

(Declaration by the candidate for gap in education for one or more than one year of passing the last examination)

I, the undersigned hereby declare that I have passed the qualifying examination
(Mention the name of the examination i.e., class
XII/undergraduate course, etc. or its equivalent examination) from
(Mention the name of Board/University)
in the year .

I have marked the appropriate reason given below that explains my gap
from to June 2021.

a) I did not enroll my name in any college/Institute/University due to

___________________________________ therefore, there was a gap from
to June 2021 in my education.
b) I had enrolled for Program in the institute from
to but thereafter discontinued from due to
reason.

I am making the above declaration for the purpose of my admission to the

_________________________ (Name of the program) Of _____
(Mention the name of the Institute) of the Symbiosis International University.

Name of the Candidate

Signature of the Candidate
Date