FORMAT- "A"

(Declarationby the Student)

IVINITA KUMARI D/o of Sh. VINOD KUMAR
resident of 421/6 DURGA
CURUDWARA CHHATTARPUR CHATTERPUR Delhi 110074 India studying in the ASHRAM BEHIND
the program i.e. first, second, UG-3rd year (mehtio year
etc.) of the B.Arch program (name of the Program g. B.Tech., BA.. C.A.
e.
c.) in Delhi Technical Campus, (name of the University / Institute) do hereby declare that I am not
ancial assistance Isubsidy for the program from any other Agency/ Scheme ayailig any
of the
niversity/ Institution coming to know of my availing anyfinancial assistance/subsidy
Govt. In the eentf the
I undertake
ntire amount with penal interest calculated At 10% for the period commencing from the date to|fefud theof
ssistance to my /my parents bank account and till the date of of credit |
refund.

Talso understand that the

University/ Institutions is also free to Initiate any legal action againt m my
arents for any wrong/ misleading information furnished in the format of application.

(Signaturéof the Student with Date)

Witnesses (other than parents/family members)

S.No. Name and Complete Address

Signature
1. aua m Shana, HIN54 Tyaai Motalla, N.D:IH
2. Kahul Mah -

Hlat no- l05. chhottanu-4.

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 FORMAT - "A"

(Declaration by the Student)

IVINITA KUMARI D/o of Sh. VINOD
KUMAR resident
GURUDWARA CHHATTARPUR CHATTERPUR Delhi 110074 India
of 421/6 DURGA
ASHRAMi BEHINDD
S the program i.e. first,
second, etc.) of the B.Arch studying in the UG-3rd year (mentid year
to.) in Delhi Technical program (name of the Program e. g.
Campus, (name of the University/ B.Tech., BA., C.A.,
nancial assistance /subsidy for the Institute) do hereby declare that I am not
program from any other Agency/
Scheme of
ayailing any
University/ Institution coming to know of
my availing any financial the Govt. In the eventpf the
ntire amount with penal interest calculated At 10% for assistance / subsidy I
undertake tolfefujd the
$sistance to my /my parents bank account and till the date ofthe period commencing from the date of credit of
refund.
also understand
that the University/ Institutions is also free to Initiate
arents for any wrong/misleading information furnished in the format of
any legal action against m/ my
application.

2
(Signaturéof the StudentwithDate)

Witnesses (other than parents/family members)

S.No. Name and Complete Address

aua m Suonma, HN-54 Tyag Signature
Moballa, N.DH
2.

1-0
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