Nomination Form - Indira Gandhi Institute of Physical Education and ...

OFFICE OF THE RETURNING OFFICER,
STUDENT’S UNION ELECTION: 2012-2013
NOMINATION PAPER FOR THE POST OF ________________________________
Paste your
recent self
attested
passport size
photograph
INSTRUCTIONS:
1. The nomination should be filed only on this prescribed form meant for IGIPESS Students Union
Election : 2012-2013. Nomination filed on any other form shall be considered invalid.
2. The nomination paper should be filled in, signed and certified in all respects. No column should be left blank.
Incomplete form will be rejected.
3. The filled-up Nomination papers should be deposited in the sealed box kept in the Office of the
Returning Officer on working days between 10.00 A.M. to 5.00 P.M. but in any case before 3.00 P.M.
on Tuesday i.e. 4 th September, 2012, along with a Demand Draft for Rs.500/- (Rupees Five hundred
only) from a Nationalized Bank in favour of the Principal, Indira Gandhi Institute of Physical
Education & Sports Sciences.
4. Any withdrawal should be presented in writing by the candidate in person with Identity Card. No
withdrawal shall be allowed after 12.00 noon on Thursday, the 6 th September, 2012.
Name of the Candidate: ______________________________________________________
(in block letters)
Fathers’ Name: _______________________________________________________________
Class :______________________________________ Section: _________________________
Course:____________________________________ Year:____________________________
Residential Address: ___________________________________________________________
____________________________________________________________________________
Mobile No.:_____________________________ Ph. (Res.) ___________________________
e-mail: ______________________________________________________________________
UNDERTAKING AND DECLARATION BY THE CANDIDATE
1. I undertake to abide by the code of conduct as per copy attached (Appendix-I).
2. I undertake to submit in person with the Institute’s Identity Card and Bank Draft of Rs.500/- (Rupees Five
Hundred Only) in favour of the Principal, IGIPESS in the Office of the Election Officer as security deposit and
obtain a receipt thereof:-
I solemnly declare that:-
a) My age is _______ as on 16th August, 2012 and that my Date of Birth is _______.
b) I have not completed more than 7 years from the 1st July of the calendar year of my passing
10+2 examination to the 30th June immediately preceding of election.
Contd…(2)..

:: 2 ::
c) I did not contest for any of the post of Officer Bearer of IGIPESS Student’s Union earlier and that I am
not contesting for more than one post of Officer Bearer of IGIPESS Students’ Union elections now.
d) I have not been convicted of any criminal offence including moral turpitude,
nor have been punished by the University/College for an act which is coercive in nature and constitutes
a threat to life and property.
e) I have not been found guilty of, and punished for the use of unfair means in any
Examination of the University or Board.
f) I have attained the minimum attendance i.e. 75% in my preceding year of the Course.
g) I have no academic arrear i.e. to say that there is no pending papers to be cleared by me.
Date: _________________
_______________________
(Signature of the Candidate)
______________________________________________________________________________________________
Certificate by the Principal of the College/Head of the Department/Institution
This is to certify that Shri/Miss ___________________________________ is a bonafide student of Class
__________________ under Roll No._______________ of this Institute and that the declaration made by him/her is
true as per our records. He/She has signed in my presence and his/her date of birth as per record is
___________________. It is further certified that he/she has no academic arrear(s) during his/her present course of
study and that he/she has attained 75% or more attendance in his/her preceding year of the Course.
Signature of the Principal/Head
(with full Name and Official Rubber Stamp)
_______________________________________________________________________________________
Full Name of the Proposer: _________________________________________
(IN BLOCK LETTERS)
Father’s Name: ____________________________________________________
Class :_____________________________________
Section: ___________
Course: ________________________________________ Year: ________________________
Date: ______________
_______________________
(Signature of the Proposer)
Contd..(3)…
:: 3 ::

CERTIFICATE BY THE PRINCIPAL OF THE COLLEGE/HEAD OF THE DEPARTMENT/INSTITUTION
This is to certify that Shri/Ms. ________________________(Name of the Proposer) Son/Daughter of
Shri _____________________________________is a bonafide student of this college and that he/she has
signed in my presence.
Signature of the Principal/Head
(with full Name and Official Rubber Stamp)
------------------------------------------------------------------------------------------------------------------------
Full Name of the Seconder: ____________________________________________
(IN BLOCK LETTERS)
Father’s Name: _______________________________________________________
Class: _____________________
Section : ____________
Course: ________________________________________ Year: _______________
Date: _____________
_______________________
(Signature of the Seconder)
CERTIFICATE BY THE PRINCIPAL OF THE COLLEGE/HEAD OF THE DEPARTMENT/INSTITUTION
This is to certify that Shri/Ms. ________________________(Name of the Seconder) Son/Daughter of
Shri _____________________________________is a bonafide student of this college and that he/she has
signed in my presence.
Signature of the Principal/Head
(with full Name and Official Rubber Stamp)
------------------------------------------------------------------------------------------------------------------------
ADDITIONAL DECLARATION
I am not taking final year examination of the University for any Degree/Diploma or Certificate Course during
the year 2012-13.
_______________________
(Signature of the Candidate)
Date: _______________
Found Valid/invalid
Confirmed
(RETURNING OFFICER)
(ELECTION OFFICER/PRINCIPAL)