NATIONAL INSTITUTE OF TECHNOLOGY DELHI · The SC/ST/OBC candidates of Maharashtra State have to...

राष्ट्रीय प्रौद्योगिकी संस्थान गिल्ली NATIONAL INSTITUTE OF TECHNOLOGY DELHI

(मानव संसाधन गवकास मंत्रालय, भारत सरकार के अधीन एक स् वायत स संस् थान) (An autonomous Institute under the Aegis of Ministry of HRD, Govt. of India)

सेक्टरए-७, इन्स्टटटूशनलएररया, नरेला, दिल्ली-११००४०,भारत/Sector A-7, Institutional Area, Narela, Delhi-110040, INDIA

िरूभाष/Tele: +9111-27787500-503, फैक्स/ Fax: +9111-27787503

वेबसाइट/Website: www.nitdelhi.ac.in

Instructions for B. Tech. Candidates taking Admission at

National Institute of Technology, Delhi: Academic Session 2018-19

1. Physical Reporting Date as per the Schedule given in JOSSA Website.

2. Reporting Time: 10:00 AM to 05:00 PM.

3. Reporting Venue: Office of Academics (Room No. 206).

4. Each First Year B.Tech student have to fill all the Admission related forms available on our

Institute Website *(www.nitdelhi.ac.in Academics Admissions/Registration B) New

Students to be Admitted at NIT Delhi Application Forms for UG) and submit the completely

filled application forms to office of Academics.

5. Institute Fee Structure is available on Website *(www.nitdelhi.ac.in Academics Fee

Structure).

6. Each First Year B. Tech. Student have to submit the affidavits regarding anti-ragging follow

below link: https://antiragging.in/site/affidavits_registration_form.aspx

7. The Classes will commence from August 03, 2018.

8. Students are advised to check the Academic Calendar from the Institute Website

*(www.nitdelhi.ac.in Academics Academic Calendar)

9. PG regulations are available at Institute Website *( www.nitdelhi.ac.in Academics

Academics System B. Tech Rule & Regulations).

10. Please Refer the Annexure-I for the documents required for the B. Tech Admission/Physical

reporting as per JOSSA -2018 guidelines.

11. Please Contact the below office for any admission related Queries:

Academics Office, Room No. 206 (Academic Block, 1st Floor) National Institute of Technology, Delhi Sector A-7, Institutional Area, Narela, Delhi-110040.

Landline: 011-33861036/33861179

E-mail: [email protected], [email protected]

Website: www.nitdelhi.ac.in

http://www.nitdelhi.ac.in/



https://antiragging.in/site/affidavits_registration_form.aspx









Annexure- I

B.Tech. Admissions Under CSAB(JoSAA)-2018 Documents Required during Admission / Physical Reporting

Note: Each candidate is mandatorily required to produce the following documents/certificates. A candidate will not be allowed admission if he/she fails to produce original documents/certificates for verification:

S. No. Documents (To be submitted in Original) 1. Provisional seat allotment letter downloaded from the JOSSA website 2. Printout of the registration form, locked choices. 3. Original Admission Letter and Original Document Verification Certificate (Original

DVC) (Issued by CSAB/JoSAA) 4. Original birth certificate issued by competent authority/Class X (High

School) Board Certificate as proof of date of birth. 5. Four Passport size Coloured Photographs 6. Provisional Seat Allotment Letter (last round)

7. Class X (High School) mark sheet and certificate 8. Original mark sheet of Class XII / Diploma(if applicable) 9. Pass Certificate of Class XII / Diploma (if applicable) 10. Photo ID proof as per Govt. of India norms, especially Aadhaar Card. 11. Original category Certificate (OBC-NCL/SC/ST)

[OBC-NCL Certificate must be issued on or after April 01, 2018 (If Applicable). (Refer: JOSSA website “Formats for Certificates” for formats)

12. Note: Caste certificate (SC/ST/OBC) issued by Maharashtra State must be

validated by Social Welfare department (in case of SC and OBC Category) and

Tribal Welfare department (in case of ST category) of Maharashtra Government.

The SC/ST/OBC candidates of Maharashtra State have to produce their caste

validity certificate in the exact format available on JOSSA website

(https://jossa.nic.in ).

13. Undertaking in required format (for OBC-NCL Candidates Only) (If Applicable) 14. Certificate of Persons with Disability (for PWD Category) (If Applicable)

15. Character Certificate, Transfer Certificate & Migration Certificate

16. Original Grade/ mark sheet (if applicable) of qualifying examination for all semesters.

17. Proof of payment of seat Acceptance. 18. Original courses completion certificate from head of the university/ Institute in

case result is awaited. 19. Medical Certificate as per the format given on JOSSA website.

20. One sets of self- attested photocopy of all the original documents.


https://jossa.nic.in/

In addition to the above documents / certificates, the admitting candidate must also submit the following documents / certificates S. No Documents (To be submitted in Original) 1. Affidavits:

A. Affidavit (on stamp paper of Rs. 10) for giving reason for study gap (if any) duly signed by Oath commissioner / Notary public / Executive magistrate (If Applicable).

B. An Affidavit by Student (Anti Ragging Measures) (online generated).

C. An Affidavit by parent / guardian (Anti ragging measures) (online generated).

D. For students availing hostel, two sets of Affidavits in original of (B) & (C) are to be submit-ted. (Online generated).

2. An Undertaking* by the student - Institutional Formats for above documents are available on NIT Delhi institute website. The online anti-ragging form may be filled using the following link:

http://antiragging.in/site/affidavits_registration_form.aspx Note: If the original documents/certificates are not in English/Hindi, duly certified English/Hindi version/translation of such documents/certificates shall be required during verification.

http://antiragging.in/site/affidavits_registration_form.aspx






Form of Application for Registration as a student of NIT Delhi

Session 2018-19 (The candidate should fill in all the entries)

1. Name of the student in English : (In block letters)

Name of the student in Hindi :

2. Date of Birth :

3. Gender (Male / Female) :

4. Father’s name in English (In block letters) :

Father’s name in Hindi :

5. Mother’s name in English (In block letters) :

Mother’s name in Hindi :

6. Main Category (Open/SC/ST/OBC) :

7. PwD (Yes / No) :

8. Name of Qualifying Examination passed : for entry into the NIT Delhi

Board / University / Institute :

Roll No & Year of passing the exam :

Percentage / CGPA (with scale) :

9. JEE Main Roll Number :

10. JEE Main 2018 Score :

11. JEE General Rank :

12. JEE Category Rank :

13. Name of Branch admitted (at NIT Delhi) : 14. Admitted Category (Open/SC/ST/OBC-NCL/OCI/CIWG) : 15. Amount of Fee Paid (to CSAB/JoSAA/DASA) :

Paste One Photograph

here (staple 3 on

form)

Signature of Student

______________________________________________________________________________


Document Verification: (Attach Self attested copy of each document)

S. No. Name of the Document Insert (Yes or No)

1

Original Admission Letter and Original Document Verification Certificate (Original DVC) (Is-

sued by CSAB/JoSAA)

2 Seat Allotment Letter (Downloaded from CSAB/JoSAA)

3

Class X (High School) mark sheet and certificate

4 Mark sheet of Class XII / Diploma

5

Pass Certificate of Class XII / Diploma (If Applicable)

6 Photo ID proof

7 Aadhar Card / NAD (National Academic Depository) ID

8 Category Certificate (OBC/SC/ST) [OBC Certificate must be issued on or after April 1, 2017]

(If Applicable)

9 Undertaking in required format (for OBC Candidates Only) (If Applicable)

10 Certificate of Persons with Disability (for PWD Category) (If Applicable)

11 Character Certificate, Transfer Certificate & Migration Certificate

12 Medical Fitness Certificate (To be submitted in Original)

13 An Undertaking by the Student - Institutional (in original)

14 An Undertaking by the Student - for late submission of documents (in original)

15 Affidavit (on stamp paper of Rs. 10) giving reason for study gap (if any) duly signed by Oath

commissioner / Notary public / Executive magistrate (If Applicable)(in original)

16 An Affidavit by Student (Anti Ragging Measures) (online generated)

17 An Affidavit by parent / guardian (Anti ragging measures) (online generated)

18 Passport (Compulsory for international students)

Signature of Student 1. The document(s) at Sr. No. ________________________ are not produced, so he may be allowed for admission/registration provisionally subject to production of the documents on or before 15 September 2018.

Signature of Verifying Officer __________________________________________________________________________ For Accounts Branch: Balance Fee of Amount Rs. ________________ (in figures) ______________________________

____________________(in words) for admission in B.Tech.at NIT Delhi is collected from above student.

Signature of Accounts Branch with stamp __________________________________________________________________________ For Academic Branch: Registration Number: Roll Number: Branch: Section & Subsection: Signature Academic Branch



सेक्टरए-७, इन्स्टटटूशनलएररया, नरेला, दिल्ली-११००४०,भारत/Sector A-7, Institutional Area Narela, Delhi-110040, INDIA



Hostel Request Form Hostel Name.______________

To ,

The Warden

Hostel Name ,

NIT Delhi

Sir,

It is requested that I may be allotted a room in the Hostel. I have carefully gone through the

instructions mentioned overleaf and certify that I will abide by the rules and regulations of the hostel. Further, I

shall also be responsible for the furniture, Fixtures and fitting in my room. In case of violation, I may be imposed

any penalty/fine, which the authorities may deem fit. My particulars are as under:

Name (Capital) : ……………………………………………………………………………………………………………….

Date of Birth : ………………………………………Blood Group: ……………………………………………………...

Roll No. : .……………………………………..Branch: ……………………………………………………….........

Father's Name: ………………………………………Mother’s Name: …………………………………………………..

Quota (HS/OS): ……………………………………….Nationality: ………………………………………………………..

If Foreign National (a) Passport No.:………………(b)Visa No.: …………………..(c) Duration of Visa: ……………...

Permanent address: …….….………………………………………………………………………………………………..

……………………………………………………………………………………………….Pin Code………………………..

Phone No. &/or Mobile No. : …………………………….E-Mail ID: ……………………………………………………....

Local Address : ………………………………………………………………………………………………………...

Guardian Name: ……………………………………Contact No.: .................................................................................

Date: ……………………….. Signature of Applicant …………………………….....

(Countersign of the Parents/Guardian) with date ……………………………………………………………………….

(For Office use only)

Received hostel fee of Rs ………………………………………(………………………………………………………..)

Date:………………………… Signature of dealing Assistant/Supt A/A…………………….

Room Allotted: ………………………………………………………………………………………………………………..

Received the following(yes/No):

I. Bed…………………. 2. Study Table………………… 3. Study Chair ………………. 4. Fans ……………………..

5. Bulbs Holder/Tube Fittings …………………………….. 6. Any other ………………………………………………….

(Signature of Applicant)

Signature of Hostel Official

Warden

Photo


Instructions:

1. Rules and regulations concerning hostels enforced from time to time arc to be strictly followed.

2. The room allotted must be occupied first before making any request for repair/maintenance.

3. The inmate own is full responsible for the security of room fittings, fixtures and furniture. Proper

inventory needs to be signed at the time of allotment of room and the items issued ought to be

surrendered in the same condition at the time of vacating the room. Any damage will be chargeable

for the inmates.

4. The hostel inmates are required to deposit mess fee in advance (adjustable) for mess bills as per

instructions.

5. Hostel inmates are not allowed to permit any outsider in their rooms in the hostel for any reason

what so ever, without the prior permission of the warden.

6. An inmate can have laptop, camera, mobile, PC etc. on his own risk. The hostel administration

shall not be responsible for any kind of loss/damage of such items.

7. The inmates are advised to get these items insured in their own interests. The inmates are required

to be decent in their behavior and dresses in and around the hostel premises as well as in mess

and common/TV room.

8. The following are strictly prohibited in the hostel and the defaulters will attract harsh punishment:

i) Ragging is a cognizable offence. Any reported incident shall lead to filing of FIR with the police

by the institute

ii) Smoking, consumption of alcohol, drugs and other intoxicants is strictly prohibited

iii) Writing on the walls, doors, cupboards etc. and pasting obnoxious posters in the rooms shall be

treated as acts of indiscipline.

iv) Use of VCR/VCD and screening of movies on the computer is banned in the hostels.

v) The inmates are advised not to misuse electricity/water etc. and observe cleanliness.

9. The hostel inmate is permitted to leave the hostel after intimating (formally) to the hostel

warden for his/her home as per the address available with the hostel. In case he/she goes

anywhere else after leaving the hostel, the hostel administration shall not own any

responsibility for the same. The parents are requested to make a note of the same.

10. The inmates have to sign their presence in the daily attendance register maintained in the

hostel as per the instructions.

11. It is the responsibility of the parents/students to inform the change of contact detail/home

address/parent's telephone number in case of change.

12. In case of emergency the authorities will have the right to ask any inmate to vacate his/her room

without providing any alternative accommodation.

13. In any circumstance, the decision of the Chief Warden shall be a binding on the hostel inmates.

14. The parents and hostel inmates are required to make a note of the important telephone numbers of

the Warden and other authorities of National Institute of Technology Delhi available on different

banners at prominent places and on Institute website.

15. It is mandatory for the parents/guardians of the students to intimate the authorities of NIT Delhi in

case their ward informs them about being ragged or being involved in any act of ragging.

16. The student will abide by the rules and regulations of hostel and will obey the 'gate timings'

enforced from time to time.

17. In case of emergency, students may call to Chief Warden/Warden.

"Ragging is prohibited as per the decision of the Supreme Court of India in Writ Petition No. (C) 656/1998"

Signature of the Student

UNDERTAKING

1. I hereby do undertake to devote myself to studies, games and such extramural

activities as are recognized by the Institute authority during my stay at the institute and

shall appear in all class tests / seminars / quizzes, mid semester examinations and

end semester examinations whenever required to do so by the concerned teacher or

institute authorities. I shall also abide by all the rules/regulations of the Institute as

amended from time to time.

2. I do clearly undertake that my name may be removed from the Roll of the Institute or I

may be finally rusticated or expelled from the institute, if I directly or indirectly take part

in any movement or agitation to stage Dharna and Strike in the institute for any

reasons whatsoever, or which induces directly any other activity that in the opinion of

the institute is subversive of institute’s discipline.

3. I also do undertake that concealment of any material fact in any application or

furnishing of wrong information which might be detected at any stage even after my

admission may render me disqualified and any amount paid by me towards institution

fees etc. may stand forfeited.

4. I hereby declare that I was never involved or punished in any case of indiscipline

during my School/College career so far. There is no enquiry pending against me with

the School/College/ Police/District authorities or any other relevant authority in India or

Abroad. In case the above declaration is proved false, then my admission in the

National Institute of Technology, Delhi may be cancelled, the amount deposited be

forfeited, and I would not be entitled to any claim whatsoever on the account.

5. I have gone through the rules and regulations regarding ragging and disciplines of the

Institution.

6. I hereby solemnly affirm that I shall abide by all the orders of the institute authorities for

violation of these rules. I will have no claim against the order of the rustication, and/or

expulsion from the institution and/or hostel.

Date: Signature of Candidate

I certify that my son/daughter/ward seeks the admission with my knowledge and consent that I held

myself responsible for his good conduct, maintenance of discipline, and timely payment of fees

during the period he/she is on the Institute Rolls. I undertake to make the payment of Mess and

other dues of my son/daughter/ward regularly and timely. I have carefully studied the above

undertaking.

Date: Signature of Parents / Guardians

Permanent

Address

Pin Code

Email

Phone / Mobile

UNDERTAKING FOR LATE SUBMISSION OF DOCUMENTS

I, ______________________________________________ (name of student) admitted in

_____________________________(name of course) undertake to produce the following certificate(s) related to

my admission at National Institute of Technology Delhi latest by 15 September 2018:

1.

2.

3.

4.

5.

6.

7.

I understand that, in case I fail to produce the above certificate(s) by 15 September 2018, my admission will be

automatically and summarily cancelled without showing any reason thereof and all my fees paid by me will be

forfeited.

Date: Signature of Student

Name:

I understand that my ward has not produced the above certificates during admission, and the same has to be

submitted by him/her by 15 September 2018. I have carefully studied the above undertaking.

Date: Signature of Parents / Guardian

Name:

Formats for Certificates

OBC Undertaking

OBC Undertaking

Declaration / undertaking - for OBC Candidates only

I, ____________________ son/daughter of Shri ______________ resident of village/town/city ____________ district

____________ State hereby declare that I belong to the ___________ community which is recognised as a backward

class by the Government of India for the purpose of reservation in services as per orders contained in Department of

Personnel and Training Office Memorandum No.36012/22/93- Estt. (SCT), dated 8/9/1993. It is also declared that I do

not belong to persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to the above referred Office

Memorandum, dated 8/9/1993, which is modified vide Department of Personnel and Training Office Memorandum

No.36033/3/2004 Estt.(Res.) dated 9/3/2004.I also declare that the condition of status/annual income for creamy layer of

my parents/guardian is within prescribed limits as on financial year ending on March 31, 2018.

Place: Signature of the Candidate

Date:

Declaration/undertaking not signed by Candidate will be rejected

OBC Certificate Format

OBC Certificate Format

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS / ADMISSION TO CENTRAL EDUCATIONAL INSTITUTES (CEIs), UNDER THE

GOVERNMENT OF INDIA “This certificate MUST have been issued on or after 1st April 2018.”

This is to certify that Shri/Smt./Kum. _____________________________ Son/Daughter of Shr i/Smt. ______________________________ ____

of Village/Town ________________________________ District/Division __________________________ in the _________ ________________

State belongs to the ________________________ Community which is recognized as a backward class under:

1. Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette of India Extraordinary Part I Section I No . 186 dated 13/09/93.

2. Resolution No. 12011/9/94-BCC dated 19/10/94 published in the Gazette of India Extraordinary Part I Section I No. 163 dated 20/10/94. 3. Resolution No. 12011/7/95-BCC dated 24/05/95 published in the Gazette of India Extraordinary Part I Section I No. 88 dated 25/05/95. 4. Resolution No. 12011/96/94-BCC dated 9/03/96. 5. Resolution No. 12011/44/96-BCC dated 6/12/96 published in the Gazette of India Extraordinary Part I Section I No. 210 dated 11/12/96. 6. Resolution No. 12011/13/97-BCC dated 03/12/97. 7. Resolution No. 12011/99/94-BCC dated 11/12/97. 8. Resolution No. 12011/68/98-BCC dated 27/10/99. 9. Resolution No. 12011/88/98-BCC dated 6/12/99 published in the Gazette of India Extraordinary Part I Section I No. 270 dated 06/12/99. 10. Resolution No. 12011/36/99-BCC dated 04/04/2000 published in the Gazette of India Extraordinary Part I Section I No. 71 dated

04/04/2000. 6. Resolution No. 12011/44/99-BCC dated 21/09/2000 published in the Gazette of India Extraordinary Part I Section I No. 210 dated

21/09/2000. (xii) Resolution No. 12016/9/2000-BCC dated 06/09/2001. (xiii) Resolution No. 12011/1/2001-BCC dated 19/06/2003. (xiv) Resolution No. 12011/4/2002-BCC dated 13/01/2004. (xv) Resolution No. 12011/9/2004-BCC dated 16/01/2006 published in the Gazette of India Extraordinary Part I Section I No. 210

dated 16/01/2006. Shri/Smt./Kum. ________________________ and/or his family ordinarily reside(s) in the __________________________ District/Division of

________________________ State. This is also to certify that he/she does not belong to the persons/sections (Creamy Layer) mentioned in

Column 3 of the Schedule to the Government of India, Department of Personnel & Training O. M. No. 36 012/22/93-Estt.(SCT) dated 08/09/93

which is modified vide OM No. 36033/3/2004 Estt.(Res.) dated 09/03/2004.

Date: District Magistrate/ Deputy Commissioner, etc. Seal NOTE:

(a) The term ‘Ordinarily’ used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. (b) The authorities competent to issue Caste Certificates are indicated below:

(i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner / Additional Deputy Commissioner / Deputy Collector / First C lass Stipendiary Magistrate / Sub-Divisional magistrate / Taluka Magistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of Ist Class Stipendiary Magistrate).

(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate. (iii) Revenue Officer not below the rank of Tehsildar and (iv) Sub-Divisional Officer of the area where the candidate and / or his family resides.

OBC Certificate issued from Maharashtra State must be validated by social welfare Department of Maharashtra Government

SC/ST Certificate Format

FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE

This is to certify that Shri/Smt./Kum._____________________________________________________________ Son/Daughter of Shri ____ ____________ _______________________________of village/Town_______________________in District/ Division _____________________________ of the State/Union Territory _____________________________ belongs to the __________________ caste/Tribe, which is recognized as a Schedule Caste/Scheduled Tribe under.

The Constitution (Scheduled Castes) order, 1950. The Constitution (Scheduled Tribes) order, 1950. The Constitution (Scheduled Castes)(Union Territory ) order, 1951. The Constitution (Scheduled Tribes) (Union Territory ) order, 1951. (As amended by the Scheduled Castes and Scheduled Tribes (Modification) Order 1956, the Bombay Reorganization Act, 1960, the Punjab Reorganization Act, 1966, The State of Himachal Pradesh Act, 1970, the North Eastern Areas (Reorganization Act, 1971) and the Scheduled Castes and Scheduled Tribes orders (Amendment) Act, 1976.) *The constitution (Jammu & Kashmir) Scheduled Caste Order, 1956; *The Constitution (Andaman and Nicobar Islands) Scheduled Tribes, 1959, as amended by the Scheduled Castes and Scheduled Tribes orders (Amendment) Act. 1976; *The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order 1962; *The Constitution (Dadra & Nagar Haveli) Scheduled Tribes Order, 1962; *The Constitution (Pondichery) Scheduled Castes Order, 1964; *The Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967; *The Constitution (Goa, Daman &Dieu) Scheduled Castes Order, 1968; *The Constitution (Goa, Daman &Dieu) Scheduled Tribes Order, 1968; *The Constitution (Nagaland) Scheduled Tribes Order, 1970; *The Constitution (Sikkim) Scheduled Castes Order, 1978; *The Constitution (Sikkim) Scheduled Tribes Order, 1978; *The Constitution (Scheduled Castes) Orders (Amendment) Act, 1990. *The Constitution (Scheduled Tribes) Order, (Amendment) Ordinance, 1991. *The Constitution (Scheduled Tribes) Order, (Second Amendment) Act, 1991. *The Constitution (Scheduled Tribes) Ordinance, 1996

This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes Certificate issue to Shri ____________________________________________Father of Shri _____________________________________ ______of village/town__________________________________ in District/Division _________________________________ of the State/UT _______ __________ _____________who belongs to the ___________________ caste/Tribe which is recognized as a SC/ST in the State/Union Territory __________________________________ issued by the ____________________________________ (name of the prescribed issuing authority) vide their No. ______________________________________________ dated _______________ or Shri ____________ _____________________________ and or his/her family ordinarily reside(s) in Village/Town __________________________of ___________________ District/Division of the State/Union Territory of ____________________. Place______________

Signature______________

Date_______________ Designation ____________

(With seal of Office)

NOTE: - The terms ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. SC Certificate issued from Maharashtra State must be validated by Social Welfare Department and ST Caste certificate must be validated by Tribal Development Department of Maharashtra Government.

LIST OF AUTHORITIES EMPOWERED TO ISSUE CASTE/TRIBE CERTIFICATE:

1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner /Additional Deputy Commissioner/Dy .Collector/ 1st Class Stipendiary Magistrate/Sub Divisional Magistrate/Extra Assistant Commissioner/ Taluka Magistrate/Executive Magistrate.

2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate. 3. Revenue Officers not below the rank of Tehsildar.

4. Sub-Divisional Officers of the area where the candidate and/or his family normally resides.

PwD Certificate Format

Format for Physically Challenged (PH)/Persons with Disabilities (PwD) Certificate (To be obtained by the candidate)

(To be filled by Medical Board notified under PwD Act) Affix here recent

Photograph showing The disability duly

Attested by Medical Superintendent /CMO/Head of

Hospital (with seal)

Certificate No:

Date:

This is to certify that Mr./Ms______________________________________________________________

son/daughter of Mr./Mrs._____________________________________________________ Age

______________male/female,Registration No._____________________________is a case of

______________________________.He/She is physically disabled/visual disabled/speech and hearing

disabled/having mental retardation/leprosy cured and has ______ %(______________________per cent) permanent

(physical impairment/visual impairment/speech and hearing impairment etc.) in relation to his/her

__________________________________________.

Note:

This condition is progressive/not progressive/likely to improve/not likely to improve*.

1. Re-assessment is not recommended/ is recommended after a period of___________ months /years*. (*Strike out whichever is not applicable)

Signature of Dr. Signature of Dr. Signature of Dr.

Name of Dr. Name of Dr. Name of Dr.

Specialization Specialization Specialization

Seal with Degree Seal with Degree Se al with Degree

(Member, Medical Board) (Member, Medical Board) (Member, Medical Board)

Signature/Thumb impression of Patient Countersigned by the

Medical Superintendent/CMO/Head of Hospital (with seal)

Information/Guidelines:

1) Disability certificate shall be issued by Medical Board of at least three doctors duly constituted by the State or Central

government under PWD Act.(One of the members of the Board should be the specialist in the particular field for assessing

Locomotor, Visual disability ,Hearing and Speech disability ,Mental disorder and Leprosy cured)

2) For candidature under physically challenged category, candidates only with a minimum of 40% disability is required.

3) The Medical Board at Reporting Centre of CSAB will assess the Physically Challenged (PH) certificate. In case there is serious doubt about percentage of disability/ genuineness of the certificate, the candidate will be referred for reassessment to the Medical Board duly constituted by the State or Central Government under PWD Act.

Personal Details:Student's Name (In English-All CAPS) as per Matriculation Certificate

Student's Name (In Hindi)

Gender (Male/Female)

Date of Birth (DD/MM/YYYY)

Father's Name (In English)

Mother's Name

DATA ENTRY FORM FOR B.Tech STUDENTS(Academic Year : 2018-2019)

दरूभाष/Tele: +9111-27787500-503, फै स/ Fax: +9111-27787503


रा ीय ौ ोिगक सं थान िद लीNATIONAL INSTITUTE OF TECHNOLOGY DELHI

(मानव संसाधन िवकास मं ालय, भारत सरकार के अधीन एक वाय सं थान) (An autonomous Institute under the Aegis of Ministry of HRD, Govt. of India)

से टरए-७, इि टटूशनलए रया, नरेला, द ल -११००४०,भारत/Sector A-7, Institutional Area Narela, Delhi-110040, INDIA

Mother's Name (In English)

Correspondence Address (with pin code)

Permanent Address (with pin code)

Urban/Rural

Contact Number (Landline / Mobile)

Email Address

Father Mother Candidate

Father Mother Candidate

Local Guardian (Name and Address with contact details)

Main Category (Open/OpenPwd/SC/SCPwD/ST/ STPwD/OBC/OBCPwD) As per certificate

Bonafide State of Candidate (Name of State)

Religion Nationality

Blood Group Mother Toungue

Identification Mark Place of Residence (Rural / Urban)

Epic Card No. (Vote ID)

Aadhaar Card Number/ NAD ID

PAN Card NumberNearest Railway Station (From home)

Passport Number With Validity Date

Place of Birth (As per Birth Certificate)

Family Income of the Parent's (Per Annum)

Bank Details of the Student

Educational Details:

CLASSNAME OF

BOARD YEAR OF PASSING

PERCENTAGE / CGPA

MARKS OBTAINED/TOTAL

MARKS

Xth

XIIth

Exam Details:

S.B. Account No.__________________ Name of the Bank/Branch__________ IFSC Code________________________

NAME OF THE STATE (IN WHICH

SCHOOL IS LOCATED)

NAME OF SCHOOL WITH COMPLETE

ADDRESS

JEE Mains Roll Number JEE Mains Score (Current Year)

All India Rank Category Rank

Admission Details (As per CSAB/JoSAA/DASA):

Loan Details(If applicable):

Applied for Loan (Yes/No)

Hostel Requirement(If applicable):

Note:

SAT Score (For DASA students)

Allotted Category (Open/OpPwd/SC/SCPwD/ST/STPwd/OBC/OBCPwD/OCI/CIWG

Seat Alloted in Home State or Other State Quota or DASA

Hostel Accommodation Required or not (Yes/No).

In case you want to avail hostel, a separate form of hostel form of hostel must be filled and submitted to the Chief Warden office.

If Yes, Mention the details of the Bank Applied for Loan

In case you want to avail hostel facility the application form of hostel must be filled and submitted to the Chief Warden Office.

Allotted Branch

Signature of StudentDate:_________________ Name of Student:_________________

In Block letters

Registration Number:Roll Number:Branch:Section & Subsection:Hostel Name/Location and Room Number: Signature by Academic staff

To be filled by Academics Office:

In case you want to avail hostel facility the application form of hostel must be filled and submitted to the Chief Warden Office.

Declaration by Student:I hereby declare that the information given above are correct and true to the best of my knowlwdge and belief and nothing has been concealed therein. If any wrong information is found on my part, I shall be liable to face the disciplinary action.

NATIONAL INSTITUTE OF TECHNOLOGY DELHI · The SC/ST/OBC candidates of Maharashtra State have to...

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