FORM NO.

Vivekananda Institute of Professional Studies

REGISTRATION FORM (For UG Programme)
ACADEMIC YEAR 2020-21
(To be filled by the student in his/her own handwriting)

IMPORTANT: ALL INFORMATION MUST BE GIVEN IN BLOCK LETTERS

Programme __________________ CLAT/CET 2020 Rank____________________

University Enrollment No. ____________________ Category _____________________
I PERSONAL INFORMATION
Name of the Student _________________________________________
Affix recent
Father’s Name __________________________________________ coloured
Mother’s Name __________________________________________ photograph of
the student
Date of Birth __________________________________________
Sex (Male / Female) __________________ Blood Group _____________
Phone No. (Landline) _______________________ Mobile No. _______________________________
E. Mail ID ________________________________________________________________
Hobbies ________________________________________________________________
II ACADEMIC INFORMATION (Marks obtained in 12th Class Exam)
S. No. Subjects Marks School Attended Board
1.
2.
3.
4.
5. Total Marks ____________
6. Percentage in best four (%) ____________

III ADDRESS FOR CORRESPONDENCE: ________________________________________

____________________________________________________________________PIN:__________
PERMANENT ADDRESS: __________________________________________________________
______________________________________________________________ PIN: _______________
Address where the student will stay while studying in VIPS (Provide details, if not staying with
parents) ________________________________________________________________________

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 FORM NO. 1

Vivekananda Institute of Professional Studies

IV PARTICULARS OF PARENTS:

Father

Name ___________________________________________
Residential Address ____________________________________________
Affix recent
_____________________________________________________________ coloured
photograph of
State _______________________________ Pin code ______________
father of the
Phone No. (Landline) __________________ Mobile ___________________ student
E-mail ID : ____________________________________________
Occupation ____________________________________________
In case doing Business or engaged in any Profession specify the nature _________________________
Address _______________________________________________________________
_________________________________________________________________________________
Phone No. _______________________________________________________________
If employed, provide details
Name of the Office/Deptt._____________________________________________________________
Address ________________________________________________________________
__________________________________________________________________________________
Designation ________________________________________________________________
Office Phone No. ______________________
Mother

Name ___________________________________________
Affix recent
Residential Address ____________________________________________ coloured
______________________________________________________________ photograph of
mother of the
State _________________________ PIN __________________ student
Phone No. (L/Line) __________________ Mobile ___________________
E-mail ID : ____________________________________________
Occupation ____________________________________________
In case doing Business or engaged in any Profession specify the nature _________________________
Address ________________________________________________________________
_________________________________________________________________________________
Phone No. _______________________________________________________________

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 FORM NO. 1

Vivekananda Institute of Professional Studies

If employed, provide details
Name of the Office/Deptt._____________________________________________________________
Address ________________________________________________________________
__________________________________________________________________________________
Designation ________________________________________________________________
Office Phone No. __________________________

Signature of the Student

UNDERTAKING

1. I do solemnly affirm that the above information given by me is true and correct.
2. I affirm that I will not engage or involve myself in any act of indiscipline during the period of
my study in the above programme.
3. I am aware of the fact that in case my attendance falls below 75% in any subject in any
semester, I shall not be allowed to appear in the End-Term Examination of that semester in the
relevant subject.
4. In case there is change in any of the particulars given above, I will immediately inform the
Institute in writing about the same.

Date _______________
Place _______________

Signature of the Student Signature of the Parent

Form received by:

Name of the Faculty Members:

Signature of the faculty members:

Date:

3
 Form No. 2

Vivekananda Institute of Professional Studies

IDENTITY CARD FORM
(To be filled in duplicate)

(FILL IN CAPITAL LETTERS)

1. NAME OF THE STUDENT _____________________________ CLAT/CET RANK:________

2. FATHER’S NAME ___________________________________
3. PROGRAMME ___________________________________
4. BATCH __________________________________ Affix Latest

5. UNIVERSITY ENROLLMENT NO. ____________________________ Passport Size

6. DATE OF BIRTH ___________________________________ Photograph

7. POSTAL ADDRESS: ___________________________________________________

__________________________________________________
PINCODE ____________________________________________
8. PHONE NO. (LANDLINE)_________________________ MOBILE: ___________________

SIGNATURE OF THE STUDENT

Vivekananda Institute of Professional Studies

IDENTITY CARD FORM

(FILL IN CAPITAL LETTERS)

1. NAME OF THE STUDENT _______________________________ CLAT/CET RANK:________

2. FATHER’S NAME ___________________________________
3. PROGRAMME _____________________ BATCH: _____________________
4. UNIVERSITY ENROLLMENT NO. ____________________________
5. PHONE NO. (LANDLINE)_________________________ MOBILE: ___________________

SIGNATURE OF THE STUDENT

 Form No. 3

Vivekananda Institute of Professional Studies

PLEDGE

I hereby solemnly pledge that I shall devote myself to my studies, educational

programmes and other extra curricular activities as may be organized by the

authorities of the Institute during my stay here and shall appear in all the tests /

examinations in accordance with the rules and regulations made in this behalf from

time to time.

I clearly understand that in case I am found directly or indirectly taking part in any

movement or agitation prejudicial to the interest of the Institute or induce/abet

directly or indirectly any other student to do so, or participate in any other act /

activities which, in the opinion of the relevant authorities of the Institute, amounts to

violation of the Code of Conduct for the students of Vivekananda Institute of

Professional Studies, I may be fined or rusticated and my name may be removed

from the rolls of the Institute.

Date: _____________
Signature of the Student: _________________
Name _______________________________________

Programme ___________________________________

University Enrolment No. _________________________

 Form No. 4

Vivekananda Institute of Professional Studies

UNDERTAKING- 1
(BY THE STUDENT ONLY)

I ________________________________________________________(Name of the student)

S/o / D/o __________________________________________________ (Name of the Parent)

Bearing University Enrollment No.__________________________________________

pursuing ____________________________ (Programme Name), Batch _________________

hereby undertake that I shall not engage/involve in ragging of any kind whatsoever in or

around the Institute or anywhere against any other student of the Institute. I fully understand

that in case I am found engaged/involved in ragging of any kind whatsoever, strict action

including rustication from the Institute may be taken against me.

I further undertake that I will attend minimum 75% of the classes every semester

in each subject and keep my parents informed about my attendance status from time to

time. I understand that in case I fail to attend 75% of classes every semester in each subject, I

will be detained from appearing in the Internal / End Term Examination of the relevant

semester.

Date: _____________
Signature of the Student: _______________________________
Name ____________________________________________

Programme _____________________ Batch ______________

University Enrolment No. ______________________________

Mobile No. _________________________________________

Counter Signature of the Parent ________________________________

 Form No. 5

Vivekananda Institute of Professional Studies

UNDERTAKING- 2
(BY THE STUDENT ONLY)

I __________________________________________________________ (Name of Student),

S/o/ D/o __________________________________________________ (Name of the Parent),

University Enrollment No._____________________ pursuing __________________

Programme, Batch ___________________ hereby undertakes that I am not employed and

will not join any Employment or Job during my study in the Institute. I fully understand that

in case I am found employed anywhere, strict action may be taken against me.

Date __________________________________

Signature of the Student ___________________

Name _________________________________

Address _______________________________

______________________________________

______________________________________

Mobile No. ____________________________

Counter Signature of the Parent ___________________

 Appendix 4(A)

Guru Gobind Singh Indraprastha University Photograph

Sector 16 C, Dwarka, New Delhi - 110078 duly attested by
the officer who
ADMISSION VERIFICATION FORM FOR THE has certified
ACADEMIC SESSION 2020-21 this certificate
(FOR ENGINEERING, B. ARCH & PROFESSIONAL PROGRAMMES )

Name of Candidate: (Mr/Miss/Mrs) ______________________________________________________________

Address: _____________________________________________________________________________
________________________________________________________________________________
PIN Code_____________ Tele. No. (with STD code) _________________Mobile No. ______________________
Email:______________________________
Minority Community (If applicable) ______________ (Sikh / Muslim / Jain / Christian) CET Roll No.
_____________Category (SC / ST / OBC / Def / PH / Kashmiri Migrant)_____________ CET Rank ______________

1. School / College location of qualifying examination____________________________ (Delhi / Outside Delhi)

2. Date of Birth _______________Age as on 1-8-2020: years_______months ____days ___________
(As per Secondary School Certificate)
3. Passed Senior Secondary Examination / Three year Diploma in Engg/B Sc Graduation (3 yrs) ______________.
4. Aggregate percentage of all subjects in Sr. Secondary Examination/Dip. in Engg/ B Sc Graduation (3 yrs) _____.
th
5. Passed in English in 12 Class _______________________________________________________________.
th
6. PCM/PCBM Percentage in 12 Class __________________________________________________________.
7. Percentage in qualifying degree as per the eligibility condition specified in PART A of the Admission Brochure:
_____________________________.
th
8. Passed in Maths / Computer Science / Computer Applications in 12 Class _____________________________
9. Category Certificate SC / ST / OBC / PH / Defence / Kashmiri Migrants / Minority Community (Attach photocopy) :
10. Character Certificate (Attach photocopy) _______________________________________________________
11. Medical Certificate (Attach Original) __________________________________________________________
12. Passed Graduation in the year ________________Percentage of marks in graduation ____________________
13. Passed Post-Graduation in the year____________ Percentage of marks in post-graduation _________________
14. (a) NATA/GATE Score ____________________
(b) Year of Passing ____________________
15. Details of Demand Draft(s) for Submission of fees
Amt:____________ DD No.________ Bank/Branch_______________
Amt:____________ DD No.________ Bank/Branch_______________
Amt:____________ DD No.________ Bank/Branch_______________

I solemnly affirm that the information furnished above is true and correct in all respects. I have not concealed any
information. I realize that if any information furnished herein is found to be incorrect or untrue, I shall be liable to criminal
prosecution and also forgo my claim to the seat in the college. Further, that my candidature for examination/selection and
admission to the course is liable to be cancelled. I agree to abide by the rules & regulations of the University.

Signature of the Parent/Guardian & Date Signature of Candidate & Date

FOR OFFICE USE ONLY

Certificates Checked and Verified by University official/Officer during counselling:
Signature of the Deputed Officers/Officials___________________________________
Name of the Officer/Officials _____________________________________________
University Enrolment No.__________________________________
Note: Use Photocopy of this form
Page | 9 ADMISSION BROCHURE 2020-2021
 Appendix 6

Guru Gobind Singh Indraprastha University

Photograph
Sector 16 C, Dwarka, New Delhi - 110078
duly attested by
the officer who
has certified
MEDICAL CERTIFICATE** this certificate
(FOR THE ACADEMIC SESSION 2020-21)
(TO BE SUBMITTED AT THE TIME OF COUNSELLING/ADMISSION)

I certify that I have carefully examined Shri/Km/Smt.*_______________________________________

son/ daughter/wife of Shri/Smt.* __________________________________________________whose
signature is given below. Based on the examination, I certify that he/she is in good mental and physical
health and is free from any physical defects which may interfere with his/her studies including the active
outdoor duties required of a professional. Visible Mark of Identification
_____________________________________________

Signature of the Candidate__________________________________________

Place :
Date :
Name & Signature of the
Medical Officer with Seal and
Registration Number

* Strike whichever is not applicable.

** To be signed by a Registered Medical Practitioner holding a Medical degree.

Note : Use photocopy of this Form

Page | 13 ADMISSION BROCHURE 2020-2021

 Appendix 13
Guru Gobind Singh Indraprastha University
Sector 16 C, Dwarka, New Delhi - 110078

UNDERTAKING BY THE STUDENT WITH RESPECT TO ANTI RAGGING

I, _________________________________________S/D of Mr./ Mrs. /Ms.

_____________________________ , having been admitted to____________________, have received a
copy of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions,

in the said Regulations.

2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.

3) I have also, in particular, perused clause 5 and clause 6.1 of the Regulations and am fully aware of the
penal and administrative action that is 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 aver and undertake that

a)I will not indulge in any behavior or act that may be constituted as ragging under clause 3 of the
Regulations.
b) I will not participate in or abet or propagate through any act of commission or omission that
may be constituted as ragging under clause 3 of the Regulations.

5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to clause 9.1 of
the 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 the declaration is found to be untrue, I am aware that my admission is
liable to be cancelled.

Declared this ___day of __________ month of ______year.

______________________________________

Signature of deponent
Name:
Address:
Telephone/Mobile No.

VERIFICATION
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit
is false and nothing has been concealed or misstated therein.
Verified at _____on this the ____of , _____.

_____________________
Signature of deponent
Page | 24 ADMISSION BROCHURE 2020-2021
 Appendix 14
Guru Gobind Singh Indraprastha University
Sector 16 C, Dwarka, New Delhi - 110078

UNDERTAKING BY PARENT/GUARDIAN WITH RESPECT OF ANTI RAGGING

I, Mr./Mrs./Ms. _____________________________________________________ (full name of

parent/guardian) father/mother/guardian of, (full name of student with admission/registration/enrolment
number), having been admitted to ____(name of the institution) , have received a copy of the UGC
Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter

Regulations.
2) I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.
3) I have also, in particular, perused clause 5 and clause 6.1 of the Regulations and am fully aware of the
penal and administrative action that is 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 aver and undertake that
a) My ward will not indulge in any behave our or act that may be constituted as ragging under
clause 3 of the Regulations.
b) My ward will not participate in or abet or propagate through any act of commission or
omission that may be constituted as ragging under clause 3 of the Regulations.

5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to clause
9.1 of the 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 the declaration is found to be untrue, 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

VERIFICATION
Verified that the contents of this affidavit are true to the best of my knowledge and no part of the affidavit
is false and nothing has been concealed or misstated therein.
Verified at on this the of , .

________________
Signature of deponent

Page | 25 ADMISSION BROCHURE 2020-2021