AFFIDAVIT BY THE STUDENT

[Affidavit by the Student to be executed on a Non – Judicial Stamp Paper amounting to INR. 100/- (One
Hundred Indian Rupees only), duly notarized by an authorized Notary office for submission of
authenticated and self-attested copies of original valid Certificates, Documents, Testimonials for
admission purpose.]

I …………………………………………………….(Name), …………………(age) S/o or D/o Mr./Ms.

.…………………………………………………………………….., Date of
Birth…………………………………………………..(DD/MM/YYYY)) resident of
……………………………………………………………………………………………………………………….. (residential address),

do hereby solemnly sincerely affirm and declare under oath as under:

1. That, I have applied for admission in B.Tech/M.Tech/MS (Research)/M.Sc/ Ph.D/Preparatory

in the Department of ………………………………………………………………………………………………..at IIT
Indore located at Khandwa Road, Simrol, 453552, Madhya Pradesh after having fulfilled all
the eligibility criteria under the terms of required Minimum Educational Qualification (MEQ)
and Qualifying Exam (QE) for Academic Year 2021-22 (Autumn Semester).

2. That, I have applied vide application reference no/JEE 9Adv.) Roll No..
……………………………………….. dated ……………………………. and have paid the requisite seat
acceptance fee amounting to INR. ……………………………………………… (amount in words) vide
transaction ID/ref. no. ……………………………………….. dated ………………… .

3. That, due to unprecedented situation created by COVID 19 pandemic, I am fully aware of the
fact that, I am unable to physically produce and submit my original certificates, documents
and testimonials concerning the admission application to the Institute in support of my claim
for meeting and clearing the eligibility criteria under MEQ, QE, Caste/Category Certificate,
Income Certificate etc. However, at the time of making the requisite application for
registration to the Institute, I clearly affirm and declare that all the self-attested copies in lieu
of the original certificates, documents and testimonials submitted online to designated e-mail
address/ e-platform of the Institute are absolutely genuine, authentic and valid. I further
confirm that all the copies of aforesaid documents, certificates etc have been duly issued and
generated by the recognized/authorized institutions/departments concerned.

4. That, in the event at any time after execution of this Affidavit, it is revealed or discovered by
the Institute that relevant copies of the certificates/testimonials in lieu of the originals
submitted online to the Institute, are found to be invalid and/or forged, the Institute reserves
the right to take any disciplinary action including termination of my admission application with
immediate effect and/or any other action as may deem fit to the Institute.
 5. That all the particulars and declarations made hereinabove by myself, are true and correct to
my knowledge and belief, and nothing has been concealed, misrepresented or false of any fact
therefrom.

Signature of the Deponent

(Signature and Stamp of the authorized Notary)

Name of the Applicant:

Date:

Place:

Witnesses along with their signatures and date: