INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI

SOLEMN AFFIRMATION OF CONFORMANCE TO RULES AND REGULATIONS

(to be submitted by all Students / Scholars of IIT Tirupati)
(TO BE FILLED ALL IN CAPITAL LETTERS)

I, Mr./Ms………………………………………………………………………………………………,

assigned with IIT Tirupati Roll No…………………………………….., am the son/daughter/ward of

Mr./Ms. ……………….………………….……………………………………………………………,

Residing at Door No. ………………………………House No……..……..……………….………….,

Street Name: . ……………………………………………………....……………………...……………,

Local Area Name: . ………………………………………………………………..……………………,

Village/Town/City Name: .……………………………………………………………………….……..,

State: . ……………………………………………………… . Pin code:………………………..……,

am joining as a student of …………………… Programme in Department of ……………….………..,

………………………………………………………

I hereby declare that, I:

a) have read and understood the prevailing rules of regulations of the Institute
b) am aware of
(i) The national laws pertaining to ragging,
(ii) The serious consequences of this impermissible behavior, and
(iii) The administrative, legal and penal actions that will be imposed on persons apprehended,
tried and convicted of this crime; and
c) am aware of the ban on the possession and/or use of alcohol or tobacco in any form and any
powered vehicles by students inside the IIT Tirupati Campus.
Keeping the above in mind, I SOLEMNLY AFFIRM that:
a) I SHALL NOT violate the prevailing rules and regulations of IIT Tirupati, my INSTITUTE;
b) I SHALL NOT indulge in ragging, nor will encourage, abet, or be indifferent towards others engaging
in ragging; and, on the contrary, will work to ensure the dignity, honour and self-esteem of all
students;
c) I SHALL NOT possess and/or use any alcohol or tobacco product and powered vehicle inside the
IIT Tirupati campus, except with the due permission, if applicable, and that

I understand that if I am found violating or to have violated any of the rules and regulations
pertaining to students of IIT Tirupati, I am liable to obey the rulings of the respective official
authorities or Committees of IIT Tirupati and/or pay the penalty specified by them.

Signature of Student Counter Signed by Parent/Guardian

Place: Tirupati
Date:

Please visit https://iittp.ac.in/pdfs/btech/B.Tech-Ordinance-Regulations-2018.pdf

 SELF DECLARATION BY THE STUDENT

1) I, ________________________________________________________
_______________________________________________ (Full name of student in CAPITAL letters with
roll number) S/o D/o Shri./ Smt. ___________________________________________
___________________________________________________________ having been admitted to Indian
Institute of Technology Tirupati, have:
(a) Been advised to read carefully and understand the Supreme Court Judgement on Ragging hosted
in http://iittp.ac.in/anti-ragging/
(b) Received a copy of the Essential Extracts of relevant Regulations on Curbing the Menace of
Ragging in Higher Educational Institutions, 2009, (hereinafter called the relevant Regulation)
(c) Carefully read and fully understood the provisions contained therein.
2) I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what constitutes ragging
and the implications thereof.
3) I have also, in particular, understood Clause 7 and Clause 9.1 of the relevant Regulations and am fully aware of
the penal and administrative actions that are liable to be taken against me in case I am found guilty of or abetting
ragging, actively or passively, or being part of a conspiracy to promote ragging.
4) I hereby solemnly state and undertake that:
a) I will not indulge in any behavior or act that may be considered as ragging under Clause 3 of the
relevant Regulations.
b) I will not participate in or abet or propagate through any act of commission or omission that may be
considered as ragging under Clause 3 of the relevant Regulations.
5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to Clause 9.1 of the relevant
Regulations, without prejudice to any other criminal action that may 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 in any Institution in the country on
account of being found guilty of abetting or being part of a conspiracy to promote ragging and further affirm that,
in case this declaration is found to be untrue, I am aware that my admission is liable to be cancelled.
Place:

Date:
Signature of Student
Name: Telephone/Mobile No:

Address:
SELF-DECLARATION
Verified that the contents of this self declaration are true to the best of my knowledge and no part of the declaration
is false and nothing has been concealed or misstated therein.
Place:
Date: Signature of Student
 SELF DECLARATION BY PARENTS/GUARDIANS
1) I, Mr./Mrs./Ms. _______________________
_________________ (Titles, Full name of Parents/Guardians in CAPITAL letters)
Father / Mother / Guardian of Mr. / Ms. ___________________________________________________
________________________________________________ (Full name of student in CAPITAL letters
with Roll number) who has been admitted to Indian Institute of Technology Tirupati have:

(a) Been advised to read carefully and understand the Supreme Court Judgement on Ragging hosted
in http://iittp.ac.in/anti-ragging/
(b) Received a copy of the Essential Extracts of relevant Regulations on curbing the Menace of
Ragging in Higher Educational Institutions, 2009, (hereinafter called the relevant Regulations)
(c) Carefully read and fully understood the provisions contained there-in.
2) I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what constitutes
ragging and the implications thereof.
3) I have also, in particular, understood Clause 7 and Clause 9.1 of the relevant Regulations and am fully
aware of the penal and administrative actions that are liable to be taken against my ward in case he/she is
found guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
4) I hereby solemnly state and undertake that:
a) My ward will not indulge in any behavior or act that may be considered as ragging under Clause 3
of the relevant Regulations.
b) My ward will not participate in or abet or propagate through any act of commission or omission
that may be considered as ragging under Clause 3 of the relevant Regulations.
5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to Clause 9.1 of
the relevant Regulations, without prejudice to any other criminal action that may be 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 in any Institution in the
country on account of being found guilty of, abetting or being part of a conspiracy to promote ragging, and
further affirm that, in case this declaration is found to be untrue, my ward’s admission is liable to be
cancelled.

Name:
Address: Signature of Father/Mother/Guardian
Telephone / Mobile No.

SELF DECLARATION by PARENTS/GUARDIAN

Verified that the contents of this self declaration are true to the best of my knowledge and no part of the self
declaration is false and nothing has been concealed or misstated therein.

Place: Signature of Father/Mother/Guardian

Date:
 INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506

Students’ Datasheet
Department: Roll No:
(Please fill this at the time of admission)
(Affix recent passport
size photo here)

Date of Joining:

A. PERSONAL INFORMATION:

JEE (Adv) Registration No: All India Rank:

1. Full Name (in Block letters as per

JEE Allotment letter)
(All Certificates, Grade Cards &
Transcript will be issued in this name
only)

2.Date of Birth (DD/MM/YYY) 3. Gender (M/F) 4. Blood Group 5. Height (Cm)

6. Weight (Kg) 7. Nationality 8. Category(Gen/EWS/OBC-NCL/SC/ST/PwD)

9. BPL Category (If yes, supporting documents) 10. Religion

11. State of Domicile 12. Mother Tongue

13. ID Marks 14. Presently reside at (Hostel address to be filled after admission)

15. Bank details: a. Name of Bank b. Branch c. A/c No d. IFSC

16. Mobile No: 17. Passport No: 18. E-mail Id:

19. Aadhaar No (photocopy to be attached):

20. EDUCATIONAL INFORMATION:

Examination Passed Medium of Board / University Year of Division/ % of Marks /

Discipline
(All Preceding Examinations) Instruction / Institute passing Class CGPA

HSC (10 Level) or Equivalent

H.S. (10+2 Level) or Equivalent

B. PARENTAL INFORMATION:
21. Father’s Name Phone No.(with STD code) Mob e-mail id
(full name in block letters)

22. Mother’s Name

(full name in block letters)

23. Guardian
(full name in block letters)

Father Mother Guardian

24. Occupation

25. Income (Income Certificate to be

attached)
C. RESIDENTIAL INFORMAION:

26. Present Address for Communication 27. Permanent Address

State: Pin: State: Pin:

I do hereby declare that the information furnished by me is true to best of my knowledge, belief & based on records

Signature of the Student :

Date :

Name of Parent/Guardian :

Signature of the Parent/Guardian :

Date :