KIT - KALAIGNARKARUNANIDHI INSTITUTE OF TECHNOLOGY

(AN AUTONOMOUS INSTITUTION)

Coimbatore-641402.
ACCREDITED BY NAAC WITH ‘A’ GRADE & NBA (CSE, ECE, EEE & MECH.)

SELF – DECLARATION FORM

To be submitted by Student / Parent at the time of rejoining the College / Hostel

Student Name: Roll No. :

Department : Student Mobile No :

Parent Name : Parent Mobile No :

 I am aware that any Student / Staff can be an asymptomatic carrier of COVID – 19.
 I am aware that I can be an asymptomatic carrier of COVID – 19.
 I was not in contact with any COVID – 19 positive case. If I come in contact with a
positive COVID case, I will inform the concerned authorities immediately with all the
details.
 I am aware that College is talking all the measures required to keep me safe from
COVID – 19.
 I will also follow all guidelines when I go out for my personal work.
 I am aware that in spite of following all precautions I may get infected with COVID –
19 and I will not hold the College/Hostel/Staff/Students responsible for it.
 If I suffer from fever/cold/cough/loss of smell or any other Influenza like (COVID –
19) like symptom, I will immediately report to Doctor / Hospital and also inform the
College / Department HoD / Class in-charges authorities / Hostel Wardens.
 I have submitted the copy of Vaccination Certificates (Dose 1 / Dose 2)
 I will follow all the rules and regulations stipulated from time to time by the College /
Hostel and the Government in this pandemic.

Signature of the Student: Signature of the Parent

Date :

Note : Attached valid id proof of the parent with self – attestation prior to the entry.