Annexure-1.

Undertaking from the Students as per the provisions

of Anti -ragging verdict by the Hon’ble Supreme
Court

(To be submitted at the time of Registration)

AFFIDAVIT ON STAMP PAPER OF RS.10/-

AFFIDAVIT BY THE STUDENT

I, (full name of student with admission/registration/enrolment number)

S/o /D/o Mr./Mrs./Ms

1) I have been admitted to Jaipuria Institute of Management, Noida, have received a copy of the
AICTE 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 regulation 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 behaviour 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 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 misstated therein

Verified at (place) on this date (day) of (month) (year)

Signature of Deponent

Solemnly affirmed and signed in my presence on this the (day) of (month) (year).

OATH COMMISSIONER
 Annexure-2

AFFIDAVIT ON STAMP PAPER OF RS.10/-

AFFIDAVIT BY PARENT/GUARDIAN

I Mr./Mrs./Ms. (full name of

parent/guardian) father / mother/guardian of (full name of student
with admission /registration/enrolment number),

1) I have been admitted to Jaipuria Institute of Management, Noida, have received a copy of the
AICTE 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 my ward in case he/she is
found guilty 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 behaviour 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 word 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 penal law or any law for the time being in force.

6) I hereby declare that my word 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, I am aware
that my admission my word is liable to be cancelled.

Declared this day of month of year

Signature of Deponent

Name:
Address:
Telephone/Mobile No:
 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 misstated therein.

Verified at (place) on this the (day) of (month) and (year)

Signature of Deponent

Solemnly affirmed and signed in my presence on this the (day) of month,

(year) after reading the contents of this affidavit.

OATH COMMISSIONER
 Annexure-3

(To be submitted to the Institute at the time of Registration)

CERTIFICATE OF FITNESS FROM MBBS QUALIFIED DOCTOR

(ON HIS/HER LETTER HEAD OR LETTER HEAD OF THE
HOSPITAL)
(To be obtained from a Registered Medical Practitioner)
Note: This certificate has to be submitted at the time of admission to the institute
Name of student Age: Gender : M/F

Regn. No. Category : GEN/NRI Sponsored

Father’s Name:
(To be filled by the candidate)

L. T M.I V Color Vision

H Height Weight Chest I Without Glass
Abdomen S With Glass
I
O
N
History Operation Kockh’s Colics BP
Seizures Asthma Piles Diabetes

Pulse Tonsil DNS Hernia

Pallor L.Nodes CSOM Hydrocele

EXAMINATION
Cardiovascular CNS
Respiratory GOT

Is the candidate physically (Please tick) Yes/No

handicapped/disabled
If yes, type of handicapped disability
Type I Minimum 40% permanent
visual impairment
Type II Minimum 40% permanent speech and
hearing impairment
Any other finding
Certified that the candidate is physically fit/unfit/temporarily disqualified to pursue 2-year full time
PGDM Programme of Jaipuria Institute of Management.

Signature of candidate Signature of issuing Medical Officer

(Official stamp with date)

.
 Annexure-4

CHARACTER CERTIFICATE
FROM THE HEAD OF INSTITUTION LAST ATTENDED
(To be submitted to the Institute at the time of Registration)

This is to certify that Mr./Ms. has been a bonafide

student of Course Name from to and has
passed/appeared at the University/College Name Examination in this year

Reports:
SI . Details Remarks

01 Has he/ she involved himself/ herself in any act of indiscipline YES/NO

02 Has he/ she been warned, fined or punished for any act of indiscipline YES/NO

03 Has he/ she been restricted or expelled from Hostel of College for any YES/NO
reason?
04 Has he/ she been involved in any act of indiscipline outside the College YES/NO
campus like group clashes or traction fights, etc.
05 Has he/ she been addicted to drugs or intoxicants? YES/NO

General remarks (Please state your assessment of the student):

Signature: Name: Designation:

Date:
(Seal of the Institution)

Note: In case you have a gap of more than 6 months then you need to get the certificate re issued by
the concerned authority. In case not feasible, you may get the character certificate from any Gazetted
Officer. Please don’t include above statement in the certificate
 Annexure-5

Date:

To
Jaipuria Institute of Management
A-32A, Sector-62
Noida

Dear Sir,

Sub: Undertaking

I have enrolled voluntarily my son / daughter

Roll No. in your institute to pursue PGDM (G/SM/M) 2023-25 programme. In this
connection, I hereby undertake as follows :-

1. I have understood the inherent risks of fire, earthquake, flood and pandemic etc. to which any
building including an educational institute / Hostel, is subjected to. Therefore, I shall not hold
management responsible for any loss/injury caused to my ward during his / her studies at Jaipuria
Institute of Management, including at its hostel due to such natural calamity and / or non-compliance
of safety & security rules & regulation by my ward / other students/employees / other persons or
failure of any such equipment/safety gadget etc. despite adequate precaution by the management.

2. I have understood the inherent risk involved in various co-curricular and extra-curricular activities
such as games, events, sports, swimming, excursions/education trips etc. which will be
performed/participated by my ward during the course of pursuing education in the institute and I am
voluntarily permitting institute to allow my ward to participate in the same. I shall not hold
management responsible for any loss / injury caused to my ward while pursuing said activities

3. I shall not hold management responsible for any loss / injury caused to my ward due to his / her
voluntary or involuntary acts such as suicide, while under the influence of any drug / alcohol, sexual
abuse / harassment or any similar or dissimilar act.

4. I shall not hold management responsible for any loss / injury caused to my ward outside the premises
of institute / hostel due to any reason, whatsoever, and the same will solely be at my own risk.

5. I agree that management is responsible only for framing rules & regulation, wherever necessary, only
and it is in the interest of students to follow such rules & regulation and other necessary & desirable
system / rules / practices. Management / staff will not be liable either monetarily or otherwise for
any. untoward happening due to breach / non-compliance of such rules / regulation by my ward /
other students.

6. My ward will not indulge in any immoral, unlawful and criminal activities such as intimidation,
gherao, strike, sexual advancement / abuse, caste / creed discrimination etc during his stay with the
institute and if he / she is found indulging in any such activities, management is free to take
necessary action against him / her, as it may deem fit.

7. I shall not lay any claim of any nature whatsoever, either civil or criminal against the Management/
staff for acts / events mentioned above.
8. I, on my own and on behalf of my ward agree to abide by the rules & regulations, terms & conditions
framed by institute from time to time for its students.

9. The Courts at Ghaziabad shall have sole and exclusive jurisdiction to entertain any dispute that may
arise.

(Signature of Father) (Signature of Mother) (Signature of Guardian)

PS: Any Two Signatures are required

I, the above mentioned ward, hereby undertake to follow the instructions laid down in this undertaking
and also all rules and regulations stipulated by the institute / management from time to time.

Signature of Student
 Annexure-6

For Official Communication Purpose

I hereby declare that the following information regarding my home address and other details:

Name of Student: Roll No.:

Course: PGDM (G/SM/M), Sec ( ) Batch: 2023-25

Father name: Mobile: Email:

Mother name: Mobile: Email:

Local Guardian: Mobile: Email:

Communication Address (Home)

Communication Address (Local Guardian)

Signature of student

It is stated that the information furnished above is true and correct to the best of my knowledge
and that I will be held responsible for providing any incorrect information.

The institute shall not be held responsible for any information wrongly provided by me. Further I
state that I will inform the institute officially for any change in written communication.

Signature of student

Date:
 Annexure-7
AFFIDAVIT ON STAMP PAPER OF RS.100/-

Undertaking by Parent

I , father/mother/guardian of
, Roll No. hereby, acknowledge that I am fully informed about
the admission & academic norms of the Institution. I also fully understand the AICTE requirements of
undertaking the PGDM Programme on minimum criteria set (50% in graduation) and submission of
necessary documents latest by 31st October, 2023.

2. That My ward would submit the Final Year/Final Semester Marks Sheet of
(BA / B. Sc. / B.Com / B. Tech / BBA / BE /others) by 31st October, 2023. In case my ward fails to fulfil
the minimum requirements by the stated date, I undertake to withdraw him/her from the
PGDM/PGDM(SM)/PGDM (M) Course.

3. That I undertake that if the required documents are not submitted by the above stated date i.e. 31st
October, 2023, his/her candidature for the above PGDM /PGDM (SM) /PGDM (M) Course, will be
cancelled automatically without notice. And I shall have no claim against such cancellation in any Court
of Laws, as I have been briefed and I have signed this with my free consent.

Date:

(Signature of
Parent/Guardian) Name:
Mobile No.:
Email:
Address for Correspondence:
 Annexure-8
AFFIDAVIT ON STAMP PAPER OF RS.100/-

Undertaking for Continuance in PGDM (G-SM-M)

Programme

I , S/D/o Roll No. hereby,

acknowledge that I am fully informed about the admission & academic norms of the Institution. I also
fully understand the AICTE requirements of undertaking the PGDM Programme on minimum criteria set
(50% in graduation) and submission of necessary documents latest by 31st October, 2023.

2. That I would submit my Final Year/Final Semester Marks Sheet of (BA /B. Sc. /
B.Com / B. Tech / BBA / BE /others) by 31st October, 2023. In case I fail to fulfill the minimum
requirement Criteria by the stated date, I undertake to withdraw from the PGDM/PGDM(SM)/PGDM
(M) Course.

3. That I understand that if I am not able to submit the required documents by 31st October, 2023,
my candidature for the above PGDM/ PGDM(SM)/ PGDM(M) Course, will be cancelled automatically
without notice. And I shall have no claim against this cancellation in any Court of laws as I have been
briefed and I have signed this Undertaking with my free consent.

Date:

(Signature of Student)
Name:
Mobile No.:
Email:
Address for Correspondence:
 Annexure-9

STUDENT IDENTITY CARD

BATCH: 2023-2025

(FORM TO BE SUBMITTED AT THE TIME OF REGISTRATION)

Name:

Father/Guardian Name:

Address (Permanent):

City: Pin code:

Phone (R)
Emergency Contact No.:
Blood Group:

Programme: PGDM / PGDM (SM) / PGDM

(M) Roll. No.

Hosteller/Day Scholar (Please Tick)

(To be filled and stamped by PMC Office)

Signature of Student

INSTRUCTIONS
1. Every student must carry identity card / ID Card while attending the institute failing which he/she may
be disallowed to attend the class/laboratory or use any other facility.

2. The facilities would be available only relating to the course for which the student is actually
registered.

3. Authorities including the security agency can ask for the ID card of any student at any time
particularly, at the time of paying dues, appearing in the examination, and issue of the
library books, entry to the hostels, etc.

4. Inform the Institute immediately in case the card misplaced or lost.

5. A duplicate ID-card can be issued on paying Rs.200.00.

6. Identity Card is to be submitted to the issuing authority after completion of the said course.