DECLARATION / UNDERTAKING FROM THE STUDENT

I, Ms. DHARSHINI NH NH HARIKRISHNAN (80008497), D/O HARIKRISHNAN N, a student of AHS

- [Link]. - Critical Care Technology [UG-FT-ACADEMIC] SRM School of Allied Health Sciences,
Kattankulathur, permanent resident of 9/19 DURAISAMY RAJA street ARUMBAKKAM Tamil Nadu
India 600106. Phone No: Father :8778463518, Mother :8667836515, Guardian :, do hereby undertake on this
the and state the following:-

1. I am solely responsible for providing any incorrect information supplied in the application form for registration.
I understand that In case any information in this application is found to be false or incorrect at any time (during
or after completion of the course), this shall entail automatic cancellation of my admission, if granted,
cancellation of the degree if awarded, besides rendering me liable to such action as the Institution may deem fit.

2. I will present all the original documents at the time of admission along with true attested copies of mark
sheet, transfer certificate, Aadhaar Card and other documents as required by the Institution/College.

3. I do undertake that if I am unable to present all the documents at the time of admission as stated at point
no.02, I will undertake to submit the same before the time duly prescribed by the authorities. Failing which I
accept the consequence including cancellation of admission.

4. I hereby declare that once I join the course, I will not be permitted to discontinue from the course after the
time given for such withdrawal. In case of discontinuation due to unavoidable reasons, I agree to pay the
remaining tuition fee for the entire duration of the course.

5. I understand that, attendance is must as per Institution norms. I also understand, in case my attendance falls
short of 75%, for any reason, in each course, I am aware that will not be eligible to write the semester
examinations in that course and will have to repeat the course of study as and when offered next.

6. I, hereby declare that, I will neither join in any coercive agitation/strike for the purpose of forcing the
authorities of the Institute to solve any problem, nor I will participate in any activity which has a tendency to
disturb the peace and tranquility of life of the SRMIST campus and/or its Hostel premises.

7. I hereby declare that I will not post any defamatory remarks about the institution, problems faced by me or
fellow students or any other issues in the social media such as whatsapp, facebook, instagram, quora or any
other websites. If I post any such messages in social media detrimental to the interests of the institution, I agree
to any disciplinary action taken by the institution in this regard.

8. I am aware that spamming of inbox of HoDs / Deans / and other higher authorities as a means of
representation for any type of grievance or protest or such other acts, is a nuisance and mischievous act,
thereby preventing the HoDs/ Deans/ other higher authorities from doing their productive academic work. The
department will take stringent action against such students which may culminate into disciplinary action leading
to expulsion from the Institution.

9. I hereby declare that I will not involve in any brawl, groupism, threatening fellow students with prohibited
arms, harassment of fellow students, particularly girl students, inside or outside the campus. I agree to any
disciplinary action taken against me by the institution in this regard.

10. I hereby declare that I will not consume or promote usage of liquor, drugs and other Narcotic & Psychotropic
substances inside or outside the campus. If I am found to be guilty of usage or promotion of any of these
mentioned above, I agree to any disciplinary action that includes immediate termination.

11. I, hereby declare that, I will not indulge in, or tolerate ragging in any form and I accept to give an
undertaking in the prescribed format of UGC/AICTE as per directions given by the Institution. I undertake to
face disciplinary action and legal proceedings including expulsion from the Institution and or punishment implied
by the Supreme court of India, under the prohibition of ragging act, 1997 and any amendments thereof.

12. I, also declare that, I am not suffering from any serious/contagious ailment and/or any Psychiatric /
Psychological disorder. If found suffering, the Institution has the right to take any action to preserve the
decorum of the Institution.

13. I, hereby undertake to inform the Institute, about any changes in information submitted by me, in the
Application Form and any other documents, including change in addresses and phone nos., from time to time.

14. I hereby, promise to abide by the admissible rules and regulations concerning discipline, attendance etc. of
the institute and also to follow the code of conduct prescribed for the students of the Institute, as in force from
time to time and subsequent changes/modifications/amendment.

a. I agree to pay towards the damage of the College property if any, caused by me.

b. I agree to abide by the proceedings and disciplinary actions taken by the committee constituted for the
purpose; if and when I violate the rules and regulations of the Institution. I acknowledge that the Institute has the
authority / for taking punitive actions again violation and / or non-compliance of the same.

15. I, hereby, declare that, the entries made by me in the Application Form are complete and true to the best of
my knowledge and based on records.

16. I, further declare that, my admission may be cancelled, at any stage, if I am found ineligible and / or the
information’s provided by me are found to be incorrect.

I have read and understood each of the above clauses and agree to abide by the same.

Place: ___________________
Date: ___________________ Signature of Student

DECLARATION BY PARENT/ GUARDIAN

I, HARIKRISHNAN N , (Father / Mother / Guardian) of DHARSHINI NH NH HARIKRISHNAN having

been admitted for AHS - [Link]. - Critical Care Technology [UG-FT-ACADEMIC] , SRM School of Allied
Health Sciences, Kattankulathur do hereby fully endorse the above undertaking/declaration given by my
ward and I will endeavor to ensure my ward to comply with above stated undertaking in letter and spirit.

Place: ___________________
Date: ___________________ Signature of Father / Mother / Local Guardian