ANNEXURE – II

CERTIFICATE

Name of the Applicant:………………………………………Application No.

CERTIFICATE OF DEPENDENCY ON EX-SERVICEMAN

No. Dated:
Office of the Assistant Director of Ex-Servicemen’s Welfare Board of Tamil Nadu, District Soldiers’ Sailors’
and Airmen’s Board ……………………………………………………………(Name of District).
This is to certify that Tmt./Thiru./Selvan./Selvi…………………………………………….is the Wife/Son,
Unmarried Daughter/Widow is solely dependent on the Ex-Serviceman whose particulars are furnished below.
He/she is eligible for consideration for admission during 2021-2022 to professional courses in Law
College against the reservation of seats for:
(i) Wife / Widow of Ex-Servicemen

(ii) Children of Ex-Servicemen

(iii) Children of Ex-Servicemen Died / Disabled in War /Peace Time
(iv) Children of Ex-Servicemen died in Kargil War

(Tick the relevant box)

Signature of the Candidate: Signature :
Designation :
ARMY / NAVY / AIR FORCE SERVICE PARTICULARS OF EX-SERVICEMAN
Regimental No. :
Name :
Name of the Unit in which last served :
Date of Enrollment :
Date of Discharge :
Cause of Discharge :
Whether Died /Disabled in Service :
Whether Died in Kargil War :
Character assessed at the time of Discharge :
Office Seal :
Station : Signature :
Date : Designation :
NOTE: This Certificate shall be issued by an officer of the Department of Ex-Servicemen’s Welfare Board of
Tamil Nadu not below the rank of Assistant Director ofEx-Servicemen’s Welfare Board of the district in which the
dependent is a NATIVE. The reservation is applicable only to Tamil Nadu Native Candidates.
 ANNEXURE – III (1)
]
CERTIFICATE
Name of the Applicant: ……………………………………….. Application No.

Medical Certificate for Locomotor Disability including Cerebral Palsy, Leprosy Cured, Dwarfism,
Acid Attack Victims and Muscular Dystrophy
(TO BE ISSUED BY THE DISTRICT MEDICAL BOARD)

Certified that the District Medical Board of ……………………………… (City) have this ………….day of
…………………………. 2021 examined the candidate whose particulars are given below.
Space for affixing
1. Name of the Candidate : recent Passport size
2. Father’s Name : photograph of the
3. Sex : candidate duly
4. Approximate Age : attested by
Chairman District
5. Identification Marks : 1.
Medical Board
2.

6. He/she is found to be categorized as persons with

Muscular
Locomotor Disability Cerebral Palsy Leprosy Cured Dwarfism Acid Attack Victims
Dystrophy

7. Nature of Orthopedic :
8. Extent of permanent disability in percentage :
9. Whether the candidate fulfils the following Standards and
May be considered for admission in Law College/University :
(a) Normal Blood Pressure : Yes / No
(b) Mentally Normal : Yes / No
(c) Independent in ambulation with or without caliper
but without any support : Yes / No
(d) Good standing balance with or without calipers
but without any support : Yes / No
(e) Hand function within normal limits without any aid : Yes / No
(f) Good control over bowel and bladder : Yes / No
(g) Is the disability not-progressive : Yes / No
10. Whether eligible for consideration under Differently Abled
Persons Quota : Yes / No
11. Whether the candidate is physically and mentally fit to be
Considered for admission in Law College/University : Yes / No
(If no please specify reasons)
Signature of the Applicant: ………………………………..

Member 1 Member 2 Chairman

[Signature and Seal] [Signature and Seal] [Signature and Seal]

Seal of the Medical Board

*Strike out whichever is not applicable.
----------------------------------------------------------------------------------------------------------------------------- -----------------
Note: Candidates with permanent Physical Impairment 40% and above are eligible for consideration under
reserved quota.
 ANNEXURE – III (2)

]
CERTIFICATE
Name of the Applicant: ……………………………………….. Application No.

Medical Certificate for Hearing Impaired (Deaf and Hard Hearing)

(TO BE ISSUED BY THE DISTRICT MEDICAL BOARD)

Certified that the District Medical Board of ……………………………… (City) have this …………. day of
…………………………. 2021 examined the candidate whose particulars are given below.

1. Name of the Candidate : Space for affixing

2. Father’s Name : recent Passport size
photograph of the
3. Sex : candidate duly
attested by
4. Approximate Age :
Chairman District
5. Identification Marks : 1. Medical Board

2.

6. Whether Orthopedically / Visually Impaired : Yes / No

(If yes for either one or both medical certificates for
fitness from the respective specialists to be produced)

7. Nature of hearing loss and extent of disability : RE. LE.

a) Pure tone average db ……………….. ……………….
b) Speech discrimination score ……………….. ……………….
8. a) Whether a suitable hearing aid to be used : Yes / No
b) Is the impairment non-progressive : Yes / No
9. Whether eligible for consideration under Differently Abled
Persons quota : Yes / No
10. Whether the candidate is physically and mentally fit to be
Considered for admission in Law College/University : Yes / No
(If no please specify reasons)

Signature of the Applicant:………………………………..

Member 1 Member 2 Chairman

[Signature and Seal] [Signature and Seal] [Signature and Seal]

Seal of the Medical Board

*Strike out whichever is not applicable.
----------------------------------------------------------------------------------------------------------------------------- ----------------------

Note: Candidates with hearing ability 40% and above only in the better ear with speech discrimination score of
50 % and above are eligible for consideration under reserved quota.
 ANNEXURE – III (3)

]
CERTIFICATE
Name of the Applicant:……………………………………….. Application No.

Medical Certificate for Visually Impaired (Blindness and Low Vision)

(TO BE ISSUED BY THE DISTRICT MEDICAL BOARD)
Certified that the District Medical Board of ………………………………(City) have this ………….day of
…………………………. 2021 examined the candidate whose particulars are given below.
1. Name of the Candidate :
2. Father’s Name : Space for affixing
3. Sex : recent Passport size
4. Age : photograph of the
candidate duly
5. Identification Marks : 1…………………….. 2……………………….. attested by
6. Whether Orthopedically /Audio logically Impaired : Yes / No Chairman District
(If yes for either one or both medical certificate/s for Medical Board
fitness from the respective Board has to be produced)
7. Low vision: (Person with low vision means a person with
impairment of vision of less than 6/18 to 6/60 with best
correction in the better eye or impairment of field in any
one of the following categories)
a) Reduction of fields less than 50degree :
b) Heminaopia with macular involvement :
c) Attitudinal defect involvement lower fields :

8. Categories of Visual Disability (Please choose the appropriate box)

Category Better eye Worse eye Impairment Tick (as
Applicable)
Category O 6/9 – 6/18 6/24 to 6/36 20 %
Category I 6/16 – 6/36 6/20 to Nil 40 %
Category II 6/40 – 4/60 or field of vision 10◦ - 20◦ 3/60 to Nil 75 %
Category III 3/60 – 1/60 or field of vision 10◦ F.C at 1 ft. to Nil 100 %
Category IV F.C at 1 ft. to Nil or field of vision 10◦ F.C at 1 ft. to Nil 100 %
One eyed persons 6/6 F.C at 1 ft. to Nil or 30 %
field of vision 10◦
ONE EYED persons with normal vision are not considered as disabled Note: F.C. means Finger Count
9. Whether eligible for consideration under Differently Abled Persons quota : Yes /No
10. Whether the candidate is physically and mentally fit to be
Considered for admission in Law College/University : Yes /No
(If no please specify reasons)
Signature of the Applicant: ………………………………..

Member 1 Member 2 Chairman

[Signature and Seal] [Signature and Seal] [Signature and Seal]

Seal of the Medical Board

*Strike out whichever is not applicable.
------------------------------------------------------------------------------------------------------------------- -------------------------------
Note: Candidates with low vision of 40 % Impairment and above are considered as disabled and are eligible for
considerationunder reserved quota.
 ANNEXURE – III (4)

]
CERTIFICATE
Name of the Applicant: ………………………………………..Application No.

Medical Certificate
(Autism/Intellectual disability/Specific learning disability/Mental illness)
(TO BE ISSUED BY THE DISTRICT MEDICAL BOARD)

Certified that the District Medical Board of ……………………………… (City) have this ………….day of
…………………………. 2021 examined the candidate whose particulars are given below.
1. Name of the Candidate : Space for affixing
recent Passport size
2. Father’s Name : photograph of the
3. Sex : candidate duly
attested by Chairman
4. Approximate Age : District Medical
Board
5. Identification Marks : 1.
2.

6. He/she is found to be categorized as persons with

Autism Intellectual Disability Specific Learning Disability Mental Illness

7. Extent of permanent disability in percentage ………...% (in words…………………………………………... %).

8. This condition is progressive/not progressive / likely to improve / not likely to improve*.
9. Whether the candidate is eligible for consideration under Differently
Abled Persons Quota : Yes / No
10. Whether the candidate is physically and mentally fit to be
Considered for admission in Law College/University : Yes / No
(If no please specify reasons)
Signature of the Applicant: ………………………………..

Member 1 Member 2 Chairman

[Signature and Seal] [Signature and Seal] [Signature and Seal]

Seal of the Medical Board

*Strike out whichever is not applicable.
------------------------------------------------------------------------------------------------------------------- ----------------------------

Note: Candidates with permanent Physical Impairment 40% and above are eligible for consideration under reserved
quota.
 ANNEXURE – III (5)
]
CERTIFICATE
Name of the Applicant: ……………………………………….. Application No.

Medical Certificate for Multiple Disability

(TO BE ISSUED BY THE DISTRICT MEDICAL BOARD)
Certified that the District Medical Board of ………………………………(City) have this ………….day f
…………………………. 2021 examined the candidate whose particulars are given below.
1. Name of the Candidate :
Space for affixing
2. Father’s Name : recent Passport size
3. Sex : photograph of the
candidate duly
4. Approximate Age : attested by
Chairman District
5. Identification Marks : 1.
Medical Board
2.
6. He/she is a Case of Multiple Disability. His/her extent of permanent physical impairment/disability has been
evaluated for the disabilities ticked below, and shown against the relevant disability in the table below.
Sl. Permanent Physical Impairment /
Disability Affected Part of Body Diagnosis
No. Mental Disability (in%)
Locomotor Disability Left/Right/both arms
1.
Left/Right/both legs
2. Low Vision Single eye / both eyes
3. Blindness Both eyes
4. Hearing Impaired Left/Right/both ears
5. Mental Retardation
6. Mental Illness
7. Other Specified Disabilities
7. Extent of overall permanent physical impairment in percentage ……….% (in words ………………………%)
8. This condition is progressive / non-progressive / likely to improve / not likely to improve*.
9. Whether the candidate is eligible for consideration under Differently Abled Persons Quota : Yes / No
10. Whether the candidate is physically and mentally fit to be
Considered for admission in Law College/University : Yes / No
(If no please specify reasons)
Signature of the Applicant: ………………………………..

Member 1 Member 2 Chairman

[Signature and Seal] [Signature and Seal] [Signature and Seal]

Seal of the Medical Board

*Strike out whichever is not applicable.
----------------------------------------------------------------------------------------------------------------------------- ----------------------

Note: Candidates with permanent Physical Impairment 40% and above are eligible for consideration under reserved
quota.
 ANNEXURE -IV(1)
SPORTS QUOTA-2021-2022 –LIST OF SPORTS DISCIPLINES

1. Archery 29. Mallakhamb

2. Athletics 30. Motor Sports
3. Atya Patya 31. Net ball
4. Badminton 32. Power lifting
5. Ball Badminton 33. Roll Ball
6. Baseball 34. Roller Skating
7. Basket ball 35. Rowing
8. Beach Volleyball 36. Rugby
9. Billiards and Snookers 37. Sailing
10. Body Building 38. Sepak Takraw
11. Boxing 39. Shooting
12. Canoeing & Kayaking 40. Silambam
13. Carrom 41. Soft Ball
14. Chess 42. Soft Tennis
15. Cricket 43. Squash Rackets
16. Cycle Polo 44. Swimming
17. Cycling 45. Table Tennis
18. Fencing 46. Taek-won-do
19. Football 47. Tennikoit
20. Golf 48. Tennis
21. Gymnastics 49. Throw ball
22. Handball 50. Triathlon
23. Hockey 51. Volley ball
24. Judo 52. Weightlifting
25. Kabaddi 53. Wrestling
26. Karate – Do 54. Wushu
27. Kho – Kho 55. Yachting
28. Korf Ball 56. Yogasanas
 5 YEAR B.A.LL.B. DEGREE COURSE

ANNEXURE – IV (2)

SELECTION OF CANDIDATES UNDER QUOTA FOR EMINENT SPORTS PERSONS

1. The purpose of this quota is to recognize and give weightage to the eminence in sports of the candidates and
hence marks for sports achievements alone will be considered in ranking the candidates. The candidates are
expected to continue with their good performance in sports, even after selection.
2. The highest achievement of the candidate in only one annual tournament in the sports discipline in a year
will be considered for awarding marks.
3. Selection of the candidate will be based on the marks obtained by the candidate, following the guidelines
given in the table.
Table (I) – Marks for International Achievement
Sl.No. Competition Allocation of marks
Gold Silver Bronze Participation
1. International (Representing India Category-I) 1000 850 650 300
2. International (Representing India Category- II) 500 450 400 150

Table (II) – Marks for Recognized National Achievement

Allocation of Marks
Sl.No. Competition
Gold Silver Bronze Participation
1. National Championships – Organised by 190 160 130 50
National Federations
2. School Games Federation of India (SGFI) 190 160 130 50
Meet (National Level)
3. All India Rural Sports Meet (National Level) 190 160 130 50
4. National Sports Festival for Women 190 160 130 50
(National Level)
5. National Inter School Competition (National 190 160 130 50
Level)
Table (III) – Marks for Recognized State Championships
Allocation of Marks
Sl.No. Competition
Gold Silver Bronze Participation
1. State Championship Representing Revenue 95 80 65 20
District – Organized By State Associations
Table (IV) – Marks for Recognized State Level Achievements
Allocation of Marks
Sl.No. Competition
Gold Silver Bronze Participation
1. Bharathiar Day School Meet (State Level) 80 65 50 15
2. Republic Day School Meet (State Level) 80 65 50 15
3. State Inter School Competition (State Level) 80 65 50 15
4. KVS/CBSC National Sports Meet (State 80 65 50 15
Level)
5. PYKKA (Panchayat Yuva Kridaaur Khel 80 65 50 15
Abhiyan) State Rural Competition
6. Chief Minister Trophy/SDAT State Games 80 65 50 15
(State Games)
 Table (V) – Marks for Divisional Level Achievements

Allocation of Marks
Sl.No. Competition
Gold Silver Bronze Participation
1. Bharathiar Day School Meet (Divisional Level) 60 45 30 10
2. Republic Day Sports Meet (Divisional Level) 60 45 30 10
KVS Regional / CBSE South Zone Meet
3. 60 45 30 10
(Divisional Level)

Table (VI) – Marks for District Level Achievements

Allocation of Marks
Sl.No. Competition
Gold Silver Bronze Participation
District Tournament/Sports Meet/
1. Championships conducted by District Sports 45 30 15 5
Associations
District Inter School Competition/ SAI
2. 45 30 15 5
Promotion Games (District Level)
3. PYKKA – District Level Rural Competition 45 30 15 5
4. PYKKA – District Level Women Competition 45 30 15 5
Chief Minister Trophy/SDAT State Games -
5. 45 30 15 5
District Level

Gold (I Position) Silver (II Position) Bronze (III Position)

4. (a) For International Tournaments:

Category – I : Olympics, World Cup / World Championship, Commonwealth Games, Asian Games, Asian
Championships, Junior World Cup / World Championships, Asian Junior Championships, World
University Games / Championships, World School Games, Afro Asian Games, South Asian
Federation Games and Junior South Asian Federation Games.

Category – II : All other International Tournaments notcovered under Category I and wherein, not less than six
Countries had participated and events approved by IOA and cleared by SAI, Government of India.

1. Participation/Achievement in International Tournaments will be considered only with earlier achievements

at National / State Level Tournaments.

2. Only Tournaments officially recognized by the Indian Olympic Association / respective official National
Federations will be considered for the award of marks (for each year) from [01.06.2017 to last date of
submission of application (01.06.2017 to 31.05.2018, 01.06.2018 to 31.05.2019, 01.06.2019 to
31.05.2020 and 01.06.2020 to last date of submission of application.

3. Participation /Achievements in Tournaments, with Form I alone are eligible for marks indicated in Table
(I) above.

(b) For National Tournaments:

1. The highest achievement in only one Annual Tournament, officially recognized as the Regular Annual
Championship/Tournaments by Indian Olympic Association / SDAT/ SAI/ respective Official National
Federation will be considered (for each year) for the award of marks.

2. Marks will not be awarded for Selection Trials.

(c) For State Tournaments:

1. The highest achievement in only one Annual Tournament, officially recognized as the regular annual championship /
tournaments by SDAT/ SAI/ respective official State Association will be considered (for each year) for the award of marks.

5. General Conditions:
1. For consideration of candidate seeking admission under the category of Eminent Sports Person, he/she should
enclose attested photocopies of participation certificates and the forms issued by the relevant sports authorities,
along with the application
2. Participation / Achievements from [01.06.2017 to last date of submission of application (01.06.2017 to
31.05.2018, 01.06.2018 to 31.05.2019, 01.06.2019 to 31.05.2020 and 01.06.2020 to last date of submission
of application. In Sports / Games shown in the list alone will be taken into account. National/State Level
Championships / Tournaments conducted by organizations recognized by Indian Olympic Association / Sports
Development Authority of Tamil Nadu (SDAT) / Tamil Nadu Olympic Association (TNOA) alone will be
considered for award of marks (Recognition should be relevant to the year concerned).
3. The relevant attested copies of certificates issued by the appropriate authorities as detailed below are to be
submitted along with the application.

Category Competent Authority Form/certificate

International (Representing Nation )
National (Representing State)
National (Representing State)
School Games Federation of India
(SGFI) (National Level)
National Inter School Competition
(National Level)
All India Rural Sports (National Level)
National Sports Festival for women
(National Level)
PYKKA
(PanchayatYuvaKridaaurKhelAbhiyan)
National Rural Tournament
KVS Nationals (State Level)
CBSE National Sports Meet (State
Level)
Bharathiar Day Sports Meet (State
Level)
Republic Day Sports Meet (State
Level)
State Inter School Competitions (State
Level)
PYKKA State Rural Competition
Bharathiar Day Sports Meet
(Divisional Level)
Republic Day Sports Meet (Divisional
Level)
President / Secretary of the National Sports Form -I
Federation (Recognized by IOA)
Member Secretary, SDAT / secretary of the Form -II
State Association (Recognized by SDAT /
TNOA)
Chief Inspector of Physical Education for Form – IV
National School Games Competitions
President / Hon. Gen. Secretary, SGFI Certificates
Executive Director / Director – General, Certificates
Sports Authority of India
Executive Director / Director – General, Certificates
Sports Authority of India Form - II
Executive Director / Director – General, Certificates
Sports Authority of India Form - II
Executive Director / Director – General, Certificates
Sports Authority of India
Commissioner/Joint Commissioner of KVS Certificate
A.E.O. – Sports / Secretary, CBSE Certificate
Regional Inspector of physical Education Certificate
and Chief Inspector of Physical Education
Regional Inspector of physical Education Certificate
and Chief Inspector of Physical Education
Member Secretary, Sport Development Certificate
Authority of Tamil Nadu
Member Secretary, Sport Development Certificate
Authority of Tamil Nadu
Regional Inspector of Physical Education Certificate
and Chief Education Officer
Regional Inspector of Physical Educational Certificate
and Chief Educational Officer
 Category Competent Authority From/certificate
KVS Regional Level (Divisional Assistant Commissioner of KVS Certificate
Level)
CBSE South Zone Sports Meet A.E.O – Sport/Secretary, CBSE Certificate
(Divisional Level)
District Inter School Competitions District Sports Officer Certificate
(Divisional Level)
PYKKA District Rural Competition District Sport Officer RIPE and District Certificate
District Level Competitions Education Officer

4. Open/Invitational Tournament of any kind will not be considered.

5. For Tennis, the achievements of top three players by his /her position in the ranking list published by
AITA/TNTA based on the ranking rules and the final rankings of previous four years, will be awarded
marks for achievements & participation (necessary forms from the associations are to be enclosed).

6. For Cricket, the Annual Official Championship Tournaments conducted within the country under the
auspices of TNCA/BCCI at District / State / National Level alone will be taken into consideration of that
year.

7. The participation / achievements of candidates with nativity in Tamil Nadu who represented Tamil
Nadu alone are eligible for marks under National Category.

8. Only Tamil Nadu Candidates are Eligible to apply for admission under sports Quota and only the
candidates who have studied in KVS / CBSE Schools within Tamil Nadu will be Eligible for Marks.

9. A committee for selection of candidates under Sports Quota constituted for this purpose by the
Government will rank the candidates based on the marks assigned to the certificates enclosed along with
the application.

10. All the achievement certificates are to be supported necessarily by the relevant participation certificates
and appropriate forms.

11. No further enclosures or certificates under any circumstances will be entertained after the last date for
submission of completed application.

12. Required number of candidates will be called to appear for an interview before the Committee for
verification of the originals, followed by counselling after ranking.

13. If any candidate fails to produce the requisite Original Certificates/ Forms, his/her place will be allotted
to the candidate next in rank and so on. The consequential vacancy at the end of the rank list will be filled
up from among the additional candidates according to their ranks.

14. Through counselling selected candidates will be allotted to a college under this quota based on the
ranking.
 ANNEXURE – IV (3)

Name of the Candidates: Application Number:

List of the Details of All Sports Certificates Enclosed:-

(Achievements of International, National, State, Divisional and District Level, in the descending order – If, more
number of Achievements, take additional print out and may be listed)

Name of the Eligible Mark

Name of the Month &
Meet/ Sports Gold / Silver
S. No. Certificate / Year of Remarks
Tournament/ Discipline / Bronze /
Form Issue
Championship Participation
2020-21 (Academic Year)
1
2
3
4
5
2019-20
1
2
3
4
5
2018-19
1
2
3
4
5
2017-18
1
2
3
4
5

Declaration

The information furnished above and all the enclosures submitted by me are true. Should it however be found
that any information furnished therein is untrue with respect to sports details, I realise that I am liable for criminal
prosecution and I also agree to the forfeiture of my seat under sports quota.

Signature of the Parent Signature of the Candidate

Date
 ANNEXURE – V
(Ref: G.O. Ms. No.85, Higher Education (J2) Department, dated 16.04.2010)

CERTIFICATE

It is certified that there is No Graduate in the family of Selvan/Selvi ……………........................... S/o. / D/o. Thiru
……………................................... presently residing at …………………………………… and who has applied for
professional courses during the year 2021, is eligible for Tuition Fee exemption as per the G.O. Ms. No.85, Higher
Education (J2) Department, dated 16.04.2010.

Relationship
Father/ Mother/ Whether
Educational
Sl .No. Name Brother/ Sister/ Age Degree
Qualification
Grand Father/ Holder
Grand Mother

(1) (2) (3) (4) (5) (6)

Station :
Date :

Head Quarters Deputy Tahsildar

Taluk :
District :
 ANNEXURE – VI
(Ref : G.O. Ms. No.85, Higher Education (J2) Department, dated 16.04.2010)
FIRST GRADUATE CONCESSION – JOINT DECLARATION FORM

I hereby declare the details of my family members and their education qualifications to avail the tuition fee waiver
for my studies in professional courses under the scheme of waiver of tuition fees to the students from the family where
there are no graduates.

Relationship Father /
Whether
Sl. Mother / Brother / Sister / Educational
Name Age Degree
No. Grand Father / Grand Qualification
Holder
Mother

(1) (2) (3) (4) (5) (6)

I hereby solemnly and sincerely affirm that I am the first person from my family to claim the waiver of Tuition Fee for
entire Professional Course of study and there is no graduate in my family so far. The particulars furnished above are
true. Should it, however, be found that any information furnished therein is false in material particulars on verification
at a large stage, I am liable for criminal prosecution and I also agree to return the amount equal to three times the tuition
fee waiver availed by me.

Date :
Place :
SIGNATURE OF CANDIDATE

I solemnly and sincerely affirm that I am fully aware of the above declaration and the particulars furnished in the
declaration are correct. I am liable for the criminal action/ recovery of amount equal to three times of the fees waived,
for incorrect particulars furnished.

Date :
Place :
SIGNATURE OF THE PARENT/ GUARDIAN
 ANNEXURE X
JOINT DECLARATION BY
THE CANDIDATE AND PARENT/ GUARDIAN
[This should not be enclosed along with the application.
It should be submitted at the time of admission]

I hereby solemnly and sincerely affirm,

1. That the statements made and information furnished in my son’s/ daughter’s/ ward’s application and
also in all the enclosures there to submitted by him/ her are true. Should it however be found that any
information furnished therein is untrue in material particulars, I realize that I am liable to criminal
prosecution and I also agree to the forfeiture of his/ her seat in the institution.
2. That my son/ daughter/ ward would confirm strictly to all the rules and regulations in force now or
which may be introduced in the institution hereafter and that I realize that breach of discipline and rules
on my son’s/ daughter’s/ ward’s part would entail summarily forfeiture of his/ her seat in the institution.
3. That I am aware that if my son/ daughter/ ward does not put in a minimum percentage of attendance
prescribed by the University during the year in theory and practical classes separately, my son/ daughter/
ward will not be sent for the university examination.
4. That I am aware that the curriculum for the various courses is not rigid and that my son/ daughter/ ward
will follow the syllabi for the various courses in force at the time of his/ her admission and that any
revision or modification made in the syllabi during the course of his/ her study in the Institution will be
binding on him/ her.
5. That I am aware that if my son/ daughter/ ward does not get a minimum of 75 per cent of attendance in a
particular semester he/ she will not be sent for the university examination.
6. That in case of my son’s/ daughter/ ward’s progress in studies is uniformly poor in the Institution his/
her studies are liable to be terminated by the issue of transfer certificate.
7. That in case my son/ daughter/ ward becomes a scholarship holder or comes to enjoy educational
concessions like half-fee, or full-fee etc., and does not show special progress, the scholarships or
educational concessions are liable to be cancelled and that if my son’s/ daughter’s/ ward’s conduct and
character are not good these will be cancelled.
8. That my son/ daughter/ ward is aware that breach of discipline and rules or bad conduct in the NCC
extra-curricular activities will also entail summarily forfeiture of seat in the Institution, in addition to
such other proceedings that may be taken against him/ her.
9. That I am aware that if my son/ daughter/ ward is admitted into the hostel he/ she will strictly abide by
the rules and regulations in force in the hostel and that any breach of discipline or rules or any unruly
conduct or undesirable activities will be summarily dealt with by forfeiture of seat both in the hostel and
in the institution in addition to such other proceedings that may be taken against him/ her.
10. That I am fully aware, as per the directions of the Hon’ble Supreme Court of India and Tamil Nadu
Prohibition of Ragging Act 1997, Ragging is an offence, as is banned in the institutions and anyone
indulging in ragging is liable to be punished such as expulsion from the institution and/ or rigorous
imprisonment upto 3 years, and/ or fine upto Rs.25,000/-.

Date :
Place :
Signature of the Parent/ Guardian Signature of the Candidate
 [To be filled in 20 rupees stamped
ANNEXURE – XI paper and Submitted to the College
AFFIDAVIT BY THE STUDENT at the time of admission]

1. I, (full name of student with admission/registration/enrolment number) S/o. / D/o. / Mr. / Mrs. /
Ms………………………………………… having been admitted to (name of the institution) have received a
copy of the UGC Regulations on “Curbing the Menace of Ragging in Higher Educational
Institutions,2009”, (hereinafter called the “Regulations”), carefully read and fully understood the provisions
contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and
administrative action that is liable to be taken against me in case I am found guilty of or abetting ragging,
actively or passively, or being part of a conspiracy to promote ragging.
4. I hereby solemnly aver and undertake that
(a) I will not indulge in any behavior or act that may be constituted as ragging under clause 3 of the
Regulations.
(b) I will not participate in or abet or propagate through any act of commission or omission that may be
constituted as ragging under clause 3 of the Regulations.
5. I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of the
Regulations, without prejudice to any other criminal action that may be taken against me under any penal law or
any law for the time being in force.
6. I hereby declare that I have not been expelled or debarred from admission in any institution in the country on
account of being found guilty of, abetting or being part of a conspiracy to promote ragging and further affirm
that, in case the declaration is found to be untrue, I am the aware that my admission is liable to be cancelled.

Declared this _________________ day of ____________________ month of __________________ year.

Signature of Deponent
Name:
VERIFICATION
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and
nothing has been concealed or mis-stated therein.
Verified at _____________________on this the ______________of ______________of _____________
(Place) (day) (month) (year)

Signature of Deponent

_______of______
Solemnly affirmed and signed in my presence on this _________ ________ ________
after reading the contents of this affidavit. (day) (month) (year)

OATH COMMISSIONER
 [To be filled in 20 rupees
ANNEXURE – XII stamped paper and
AFFIDAVIT BY THE PARENT/GURDIAN Submitted to the College at
the time of admission]

1. I, Mr. / Mrs. / Ms. ______________________________________ (full name of parent/guardian)

father/mother/guardian of, full name of student with admission registration enrollment number, having been
admitted to (name of the institution), have received a copy of the UGC Regulations on “Curbing the Menace
of Ragging in Higher Educational Institutions,2009”, (hereinafter called the “Regulations”), carefully read
and fully understood the provisions contained in the said Regulations.
2. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.

3. I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fully aware of the penal and
administrative action that is liable to be taken against me in case I am found guilty of or abetting ragging,
actively or passively, or being part of a conspiracy to promote ragging.

4. I hereby solemnly aver and undertake that

(a) My ward will not indulge in any behavior or act that may be constituted as ragging under clause 3
of the Regulations.
(b) My ward will not participate in or abet or propagate through any act of commission or omission
that may be constituted as ragging under clause 3 of the Regulations.

5. I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause 9.1 of the
Regulations, without prejudice to any other criminal action that may be taken against my ward under any panel
law or any law for the time being in force.

6. I hereby declare that my ward has not been expelled or debarred from admission in any institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote ragging and
further affirm that, in case the declaration is found to be untrue, the admission of my ward is liable to be
cancelled.
Declared this ________________ day of ___________________ month of _________________ year.

Signature of deponent
Name:
VERIFICATION
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit is false and
nothing has been concealed or mis-stated therein.
Verified at _____________________on this the ______________of ______________of _____________
(Place) (day) (month) (year)

Signature of deponent
______of________
Solemnly affirmed and signed in my presence on this _________ ________ ________
After reading the contents of this affidavit. (day) (month) (year)

OATH COMMISSIONER