“YUVA RAKSH”
(Group Insurance Scheme for Students)
Student’s Registration Form
(Copy to be submitted along with the Admission Form)
1. Name of the Insured Student : ——————————————————————–—
2. Class : ——————————————————————–—
3. Residential Address : ——————————————————————–—
———————————————————————–-
4. Student’s Date of Birth : ——————————————————————–—
5. Blood Group : ———————————————————————–
6. Name of the Guardian : ——————————————————————–—
7. Signature of the Guardian : ——————————————————————–—
8. Amount of Premium Paid : ——————————————————————–—
(Cash/Cheque (Details)
———————————————
Student’s Signature
————————————————————–———————————————————————————————
For Office Use Only
Received from Student (Name —————————————— of ———————————– Class)
Premium of Rs. ——————————— against receipt no.——————— dated ————————
Institute / Department / College Seal / Stamp with Signature .
(College to preserve the slip along with Admission Form)
National Insurance Company Limited
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STUDENTS’ ATTENDANCE UNDERTAKING
This is to undertake that I am aware that admission to a regular course warrants regular
attendance in the classes/practical, and that the college is implementing Mumbai Univer-
sity Ordinance 0.6086 for students’ attendance.
I declare that I shall maintain minimum 75% overall attendance and minimum 50% at-
tendance in individual subjects. I shall download the “Teach Us” Attendance App on my
mobile and monitor my attendance regularly through the same. I shall also follow all the
rules and instructions of the Attendance Committee.
I completely understand and agree that if I fail to fulfill the attendance criteria, I shall not
be allowed to appear for the semester end examination. I shall ensure that that my par-
ents/guardians also download and use the attendance app to know my attendance in the
college. In the event of shortfall in the attendance, I undertake to abide by the decision of
the college to debar me from the semester examination.
_________________________ ______________________
Name of the Student Signature of the Student
STUDENTS’ ATTENDANCE UNDERTAKING
I, the parent/guardian of the student undertake that I shall periodically monitor my
ward’s attendance in classes. I shall download the “Teach Us” Attendance App and use
the same. I shall attend the parents’ meeting convened by the Attendance Committee and
meet the teachers if necessary. I assure that my ward shall maintain the requisite attend-
ance in classes and practicals. I understand and agree that if my ward does not have mini-
mum required attendance, he/she shall not be allowed to appear for the semester end ex-
amination.
_________________________ ______________________
Name of the Parent Signature of the Parent
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BHAVAN'S COLLEGE
Andheri (W), Mumbai — 400 058
Undertaking by Student & Parent / Guardian in
Accordance with Prohibition of Ragging Act 1999
I, the undersigned----------------------------------------------------------------------------———
Son/ Daughter / Ward of -------------------------------------------------------------------------—-
(Surname) (First Name) (Middle Name)
a student of Bhavan's College, do hereby undertake as follows:
1. I am aware of the law regarding ragging as well as punishments for ragging and if found guilty
of ragging, I am liable to be punished appropriately.
2. The Prospectus provided by the College, includes all the information about the “ Action,
against ragging, Maharashtra Prohibition and Ragging Act 1999 which is in effect from 15 th
May, 1999” as well as “University of Mumbai Circular No. APD/MISC/315 of 2000, dtd. 24th
August 2000” of pages 13 to 19. I shall preserve the Prospectus and refer to the rules and regu-
lations as long as I am a student of the College.
3. I hereby also undertake not to resort to ragging as well as not to abet ragging
4. The Information about “ Anti Ragging Squad” of the College has been displayed on the Col-
lege Notice Board and I have read the same.
_____________________ _________________________
Date Signature of Student
I, the Parent / Guardian of the Student ---------------------------------------------------------
have read the undertaking signed by my son / daughter / ward and I endorse the same
________________ _____________________________
Date Signature of Parent / Guardian
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Student Undertaking for Well Being / Health
To,
The Principal
Bhavan's College
Andheri (W)
Mumbai - 400058
Respected Sir/Madam,
I ——————————————————————————————————————–
Class: ——————————— Roll No.:——————— Mobile No.: —————————–
Hereby declare that (tick what is applicable)
I am totally fit/healthy and that i do not suffer from any chronic illness
I suffer from a chronic illness termed as ————————————————————–—
For which I am under medical treatment from ————————————————————–
Dr.————————–————————— Mobile No.———————————————–
In case of emergency, the College may contact my relative who is my
(relationship)——————————————— Mobile No. —————————————
Signature of student:——————————
———————————————————————————————————————–
I, Mr./ Ms. ———————————————————————————————————
parent / guardian of Mr./Ms.———————————————— agree with the above under-
taking. I indemnify Bhavan’s College for any medical help that is extend / arranged by the college
Authorities to my ward, in case of any medical emergency. In case of such medical emergency, I
shall bear all the expense that the college may incur for the same.
Signature of Parent / Guardian: ——————————— Mobile No.: ——————————
Place:———————————— Date: —————————————
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