RE-REGISTRATION FORM - University In jaipur

RE-REGISTRATION FORM(Batch: 20 -20 )Programme :_________________Branch : _ ___________Semester :________Enrollment No. :___________________________________________________Student’s Name (in Capital letters)____________________________ _______Mobile No.____________________E-Mail Id____________________________Category (Gen/SC/ST/OBC/NRI/Foreign/Others) _________________________Physically Handicapped: Y / NMinority: Y / NSex (Male/Female):______________Date of Birth: DD /MM /YYYYFather’s Name (in Capital letters) ___________________________________________Father’s Mobile No.______________Tel. No._____________Mail Id__________________________Permanent Address : _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________FATHER’S OCCUPATION (IN DETAIL):Business/Service/Any other: __________________Name of the Post: __________________Nature of Business / Job: _____________________Office Tel No.____________________________Name of the Local Guardian: _________________________________________________________Relationship: _________________________Contact No. _____________________________Present Address: ______________________________________________________________________________________________________________________Tel. (Res.):___________________UNDERTAKINGI …………………………………………… son/daughter of ………………………………………………… age…………… sex……..…residence of ……………………….solemnly affirm:1. That the statement and information furnished by me in the Re-Registration Form for admission to ………… course for theacademic year…………. at Jagan Nath University, Jaipur and enclosures submitted with the application form are true to best ofmy knowledge and belief. I realize that if any information furnished here-in is found to be untrue in the material particulars, Ishall be liable to criminal prosecution as well as to forgo my admission to the course as well as removal from Jagan NathUniversity, Jaipur.2. That I also undertake to pay the course fee, Hostel and other fees and dues as well as fines imposed regularly.3. That I hereby agree to confirm and abide by all rules, guidelines presently in force in the university and as fully explainedin the prospectus or those that may thereafter be made for the administration of the teaching, discipline and hostel andenforced by the institution from time to time. I do declare that I will not indulge in any activities either in campus or outside,which may result in disciplinary action against me.4. I also declare that:(a) I have not been convicted of any criminal offence nor have I been released on bail in connection with criminal case.(b) No case of criminal offence or moral turpitude is pending against me in any court of law.(c) No complaint or FIR has been lodged against me by the University.(d) I have not resorted to any act of indiscipline during past years.Paste yourrecentpassport sizecoloredphotograph5. I fully understand that the University authorities/Officers/ Disciplinary Committee shall have the full liberty to expel/ rusticateme from the University for any Infringement of the rules of conduct and discipline prescribed.Date: ___/____/2012Signature of StudentSignature of Parent/GuardianThis Form is to be submitted to the Cashier /Accounts at the time of deposit of fee.(For office use only)Receipt No…………………………………….Dated……………………Signature of Cashier

ANNEXURE IAFFIDAVIT BY THE STUDENT(On a Stamp Paper of Rs.10)I,………..(full name of student with admission/registration/enrolment number)s/o d/o Mr./Mrs./Ms……………………………………………………….. , havingbeen admitted to………………… (name of the institution)……………………….. , havereceived a copy of the UGC Regulations on Curbing the Menace of Ragging in HigherEducational Institutions, 2009, (hereinafter called the "Regulations") carefully read andfully understood the provisions contained in the said Regulations.2) I have, in particular, perused clause 3 of the Regulations and am aware as towhat constitutes ragging?3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and am fullyaware of the penal and administrative action that is liable to be taken against me in case Iam found guilty of or abetting ragging, actively or passively, or being part of a conspiracy topromote ragging.4) I hereby solemnly aver and undertake thata) I will not indulge in any behaviour or act that may be constituted asragging under clause 3 of the Regulations.b) I will not participate in or abet or propagate through any act ofcommission or omission that may be constituted as ragging under clause3 of the Regulations.5) I hereby affirm that, if found guilty of ragging, I am liable for punishmentaccording to clause 9.1 of the Regulations, without prejudice to any other criminal action thatmay 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 inany institution in the country on account of being found guilty of, abetting or being pat of aconspiracy to promote, ragging; and further affirm that, in case the declaration is found tobe untrue, I am aware that my admission is liable to be cancelled.Declared this…… day of……………. month of………. year.VERIFICATIONSignature of deponent Name:Verified that the contents of this affidavit are true to the best of my knowledge and nopart of the affidavit is false and nothing has been concealed or misstated therein.Verified at (place) on this the (day) of (month) . (year)Signature of deponentSolemnly affirmed and signed in my presence on this the (day) of (month) ,(year)after reading the contents of this affidavit.OATH COMMISSIONER

ANNEXURE IIAFFIDAVIT BY PARENT/GUARDIAN(On a Stamp Paper of Rs.10)I, Mr./Mrs./Ms.------------------------------------------------------------------------------ (fullname of parent/guardian) father/mother/guardian of , (full name of student withadmission/registration/enrolment number)-------------, having been admitted o(name of the institution), have received a copy of the UGCRegulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009,(Hereinafter called the "Regulations")/ Carefully read and fully understood the provisionscontained in the said Regulations.2) I have, in particular, perused clause 3 of the Regulations and am aware as towhat constitutes ragging?3) I have also, in particular, perused clause 7 and clause 9.1 of the Regulations and amfully aware of the penal and administrative action that is liable to be taken against my ward incase he/she is found guilty of or abetting ragging, actively or passively, or being part of aconspiracy to promote ragging.4) I hereby solemnly aver and undertake thata) My ward will not indulge in any behaviour or act that may be constitutedas ragging under clause 3 of the Regulations.b) My ward will not participate in or abet or propagate through any act ofcommission or omission that may be constituted as ragging under clause3 of the Regulations.5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishmentaccording to clause 9.1 of the Regulations, without prejudice to any other criminal action that maybe taken against my ward under any penal law or any law for the time being in force.6) I hereby declare that my ward has not been expelled or debarred from admission inany institution in the country on account of being found guilty of, abetting or being pat of aconspiracy o promote, ragging; and further affirm that, in case the declaration is found to beuntrue, the admission of my ward is liable to be cancelled.Declared this-----------day of--------- month of-------------------- year.Signature of deponent Name:Address;Telephone/ Mobile No.:VERIFICATIONVerified that the contents of this affidavit are true to the best of my knowledge and no pat ofthe affidavit is false and nothing has been concealed or misstated therein.Verified at (place) on this the (day) of (month) . (year) .Signature of deponentSolemnly affirmed and signed in my presence on this the (day) of (month)(year)after reading the contents of this affidavit.OATH COMMISSIONER