NITIE, MUMBAI – 400 087

ANNEXURE - I
NOTE TO THE DOCTOR :

This applicant has been selected for the Two-Year Post Graduate Diploma in Industrial
Engineering. We seek your help in ascertaining that he/she is in good physical condition to
undertake this course.

We thank you for your co-operation.

AR (Academic) In-charge
Medical Examination Report
. Affix Passport Size Photo Here
Name:

Date of Birth: Age:

Male/Female:

Weight: _______ KG

Height: _______ CM

Nutrition ______________ Thin/Average/Obese

Temp. Pulse: Min:

BP / mm of Hg
Skin/Nails/Mucous Membrane
Reads Colour Vision
Eyes Rt
Lt.
Ears Rt.
Lt
Hearing from 20 feet

Glands

Thyroid
Teeth Good/Bad/Caries

Any physical abnormality

Resp. System Rate Cynosis

Air Entry : Good/Poor
Satisfactory
Rhonchi/Rales
Circulatory System :
Heart Sounds :
Murmurs :
P.A. Soft/Distension/Guarding/Tenderness
Liver Spleen Ascites
C.N.S. Mental disability
Locomotor System
Genito Urinary System
X-ray Chest Report
Identification Marks 1.
2.
Specimen Signature of the Candidate

Advice :

The candidate is Fit/Unfit to join the Post Graduate Programme.

Signature: ____________________________________________

Name and Address of

Registered Medical Practitioner. ______________________

_______________________

Registration No. & Seal _______________________

Date _______________________
NITIE, MUMBAI – 400 087 ANNEXURE - II

UNDERTAKING

I, student of XXX Batch Post Graduate Diploma in Industrial Engineering fully understand and
agree that the National Institute of Industrial Engineering, Mumbai will have the right to ask me
to leave the Institute during the course of the Post-Graduate Programme, should my performance
or conduct as judged by the Institute be unsatisfactory.

I further agree to abide by the regulations that the Institute may frame from time to time
regarding the evaluation, the minimum standards of academic performance and discipline
required of a student for satisfactory completion of the Post-Graduate Programme.

All the documents and information shared by me during the admission process is true to the best
of my knowledge and belief.

I agree that at any stage if it is found that the documents submitted by me is false then the
National Institute of Industrial Engineering, Mumbai will have the right to ask me to leave the
Institute during the course and the entire fees shall be forfeited.

I understand and agree that the decision of the Institute’s Director in this regard will be final.

Signature of the Student: _______________________

Name of the Student : _______________________

(in capital)
Place:
Date:
NITIE, Mumbai 400 087

Rules and Regulations Governing Admission

The Programme starts from 12th June 2023 and selected candidates are required to report at
NITIE on ____________ and submit the following documents to the Academic Office.

a) A medical certificate of fitness from a Registered Medical Practitioner (with minimum

MBBS Qualification) in the enclosed form (Annexure – I)
b) Student and the parent/Guardian have to file affidavits online giving undertaking on Anti
Ragging. The hard copy of the same to be submitted to Academic Office. The undertaking
can be filed online through the following sites:
www.antiragging.in/helpline@antiragging.in and www.amanmovement.org/kachrooraj@gmail.com

c) Undertaking in the enclosed form (Annexure-II).

d) Produce all original certificates, proof of date of birth, academic qualifications and
experience mentioned in your application for verification.

e) Physical Disability Certificate in case of PD candidates.

f) Caste Certificate/Caste Validity Certificate in case of SC/ST candidates.

g) Income Certificate obtained from the Competent Authority of your domicile as per
Central/State Government(s) is to be furnished in case of SC/ST candidates whose annual
family income is less than 4.5 lakhs for the last financial year.
h) Copy of Aadhaar Card.

i) Caste Certificate/Caste Validity Certificate and latest OBC Non-Creamy Layer Certificate
in case of OBC-NCL candidates

j) Clearance/release certificate from the present employer, if sponsored.

k) Character certificate from the Head of Institute/Organisation where the candidates are
studying/working.

l) Four copies of a recent passport size photograph (Size 2.5cm x 3.5 cm) for Identity Card.

Failure to produce any of the above-mentioned documents may lead to refusal of admission.
The students are not allowed to bring/keep two wheelers/four wheelers (any vehicle) at the
Institute.
Refund of Fees, Deposits, etc.

As per NITIE admission policy, withdrawal of admission and fee refund rules are as under:

1. If the cancellation request is received by the institute before the commencement of the
academic program, i.e., beginning of classes for the batch, an amount of Rs. 1000 will
be deducted towards processing charges and the balance amount will be refunded to the
candidate vide MoE notification 14-4/2007-U.3(A). This will be applicable till 11th
June, 2023 only.

2. If the cancellation request is received by the institute on the day of commencement of

the academic program or later, the candidate will be eligible for refund of caution
money only. This will be applicable from 12th June, 2023 onwards.

Kindly note that the Institute will not pay any scholarship/stipend to the students for
undergoing this programme. However, SC/ST students are granted financial assistance as per
the Top Class Education Scheme of Govt. of India.

Jurisdiction:

The courts in Mumbai alone shall have jurisdiction in respect of any dispute which may arise
pursuant to student’s application, admission and all other aspects relating thereto.

Enclosures :
1. Medical Certificate Form (Annexure-I)
2. Undertaking Form (Annexure-II)