Annexure IX -JA[i!

2023 Declaration Form

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Provide the ist ol aLL couGes that support your cla m that you salisry the MEQS lor varous
programmes lhal yo! have chosen Altach additionalsigned sheet(s)comblned inloa singre
document, I ne.essary Modily the Semester/Yearas peryour Qua iting Oeqree.

Nam€ of the OouB6 to be coqridercd for MEq (with cou6. cod€)

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I have submitled the folowing documents Pro.se lick (./) lre subnined docLheh(s)
o Aua iry ng oegree Cedrcale
.q7 Ouailyns Deqree Marksheet(s)ol Gll SemesteE/YeaB
hale NoT subm tred lhe fo low ng documei(s)as Ferrhe @qu remenls slaled n Adm ssion
BrochLreforJAM 2023 Plea@ tck l / ) the nissng docunent(s)

!E/ Auairyng Degree Ceniacale

L AuailynO Deoree Maftshee(s)of
I lndeEtand lhat in absence oI all documenls requned as per the criter a of lhe Adm ti.g
lnst tute my adm ss on rculd be consideEd ft provisional. I undeGland ihat in the event of
nv laillnq to orovide documenls to as@rlair the satislaction of Minimum Edu@liona
Oualncalion as per Ure deadline or the Admllting lnslitule, my provsional admission will

I hereby declare lhal aman ndianCtzen.

Pace' ll,G. r.116

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