INDIAN INSTITUTE OF TECHNOLOGY INDORE

Khandwa Road, Simrol, P.O. Simrol,

Indore, 453 552, Madhya Pradesh, India
Tele: +-0731-6603128/3490/3577

UNDERTAKING FORM

(Undertaking to be given by a PG and PhD candidate who have not uploaded any of the
documents which are mandatory for admission)
(NEW ADMISSION – 2021-22 BATCH)

I do hereby solemnly undertake that; I have not uploaded the copies of the following documents:
Tick ( ) the option(s) applicable:

Tick ( ) the
Name of Documents document NOT
uploaded
Affidavit for Document Submission
Photo (Passport size)
Signature
Date of Birth Certificate
Caste Certificate (ST/SC/OBC-NC) (If Applicable)
EWS Certificate (If Applicable)
Parental Income Certificate (If Applicable)
PwD Certificate (If Applicable)
High School or Equivalent Marksheet
High School or Equivalent Certificate
Higher Secondary or Equivalent Marksheet
Higher Secondary or Equivalent Certificate
Graduation Final Marksheet
Graduation Degree Certificate
Post-Graduation Final Marksheet
Post-Graduation Degree Certificate
Qualifying Exam Certificate/Score Card
Migration/CLC/SLC Certificate/ Transfer Certificate
Fees Payment Receipt
Medical Fitness Certificate
Anti-ragging Rules and Undertaking Form
Hall of Residence Rules and Undertaking Form
Internet Usage Policy and Undertaking Form
Dining Rules and Undertaking Form
Safety and Security Rules and Undertaking Form
Undertaking for Non-submission of certificate
Library membership Form
I am aware of the seriousness and implications of non-submission of these documents.
Nonsubmission of any of the above documents latest by (31st March 2022) may lead to termination
of my academic programme and my provisional admission will stand cancelled.
.
Full Name of the student: _____________________________________________________Category__________________

Programme:_________________________________________ Department: __________________________________________

Signature: __________________________ Date: ____________________

Countersigned by Parent/Guardian