FORM NO.

Vivekananda Institute of Professional Studies – Technical Campus

REGISTRATION FORM
ACADEMIC YEAR 2022-23
(To be filled by the student in his/her own handwriting)

IMPORTANT: ALL INFORMATION MUST BE GIVEN IN BLOCK LETTERS

Programme __________________ CET/CLAT/NIMCET 2022 Rank____________________

University Enrollment No. ____________________ Category _____________________

I PERSONAL INFORMATION

Name of the Student _________________________________________ Affix recent

coloured
photograph of
Father’s Name __________________________________________ the student

Mother’s Name __________________________________________

Date of Birth __________________________________________

Sex (Male / Female) __________________ Blood Group _____________

Whether Vaccinated (Fully / Partially) (Please Tick)

Phone No. (Landline) _______________________ Mobile No. _______________________________

E. Mail ID ________________________________________________________________

Hobbies ________________________________________________________________

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Vivekananda Institute of Professional Studies – Technical Campus

II ACADEMIC INFORMATION
Standard Subjects and % of Marks Subject-wise School/ Board/
College University
10th

12th

Graduation

III ADDRESS FOR CORRESPONDENCE: ________________________________________

____________________________________________________________________PIN:__________

PERMANENT ADDRESS: __________________________________________________________

______________________________________________________________ PIN: _______________

Address where the student will stay while studying in VIPS-TC (Provide details, if not staying

with parents)

________________________________________________________________________

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Vivekananda Institute of Professional Studies – Technical Campus

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

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

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 FORM NO. 1

Vivekananda Institute of Professional Studies – Technical Campus

Phone No. _______________________________________________________________

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 member:

Signature of the Faculty member:

Date:

4
 Form No. 2

Vivekananda Institute of Professional Studies – Technical Campus

IDENTITY CARD FORM

(To be filled in duplicate)

(FILL IN CAPITAL LETTERS)

1. NAME OF THE STUDENT _______________________CET/CLAT/NIMCET 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 – Technical Campus

IDENTITY CARD FORM

(FILL IN CAPITAL LETTERS)

1. NAME OF THE STUDENT _______________________CET/CLAT/NIMCET 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 – Technical Campus

PLEDGE

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

programmes and other extracurricular 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 a violation of the

Code of Conduct for the students of Vivekananda Institute of Professional Studies-

Technical Campus, 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 – Technical Campus

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 – Technical Campus

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

UNDERTAKING FROM RESULT AWAITED CANDIDATES FOR

SEEKING PROVISIONAL ADMISSION FOR ACADEMIC SESSION 2022-23

I/My Ward ____________________________________ (Name of the candidate), Son/Daughter/Wife of

______________________________________________________________ (Father’s/Husband’s name),
Resident of ___________________________________________________________________________
(Permanent Address) seeking admission to _______________________________________ (Name of the
Course) of GGSIP University, hereby solemnly affirm and declare:
i) that I/My ward have/has appeared in the 12th class/final semester/final year (name of the qualifying
degree) e.g. B.A., B.Sc. etc.,) _________________________ Examination, 2022 of
(Board/University) during the time of reporting in allotted College/ Institute, the result of which has
not yet been declared and is expected to be declared latest by 31st October, 2022;
ii) I have passed all the papers of the qualifying degree ____________________ (name of the qualifying
degree) examination other that the final year /final semester examination.
iii) I have no compartment as on this date in my 12th class/qualifying degree examination.
iv) I am seeking provisional admission due to non-declaration of result of final year/final semester of the
qualifying degree examination by Board/University and not on account of compartment in current or
previous years of the qualifying degree examination as on date of admission.
v) That I/My ward have/has carefully gone through the rules regarding provisional admission and fully
understand that in the event of my/my ward’s failure to submit to the concerned
Dean/Principal/Director of the concerned School/College where the admission has been granted,
appropriate proof of my/my ward securing at least ___________ marks in the qualifying examination
for admission to __________________(Name of the Course) of GGSIP University by 31st October,
2022; my/my wards provisional admission to the said course will automatically get cancelled and full
fee deposited will be forfeited.

Deponent
Verification:
Verified at ________________________ on this _________________ day of _______________, 2022
that the contents of the above Undertaking are true and correct to the best of my knowledge and belief. No
part of it is false and nothing material has been concealed therefrom.

Deponent
Notes:
i) In case the candidate is minor i.e. below 18 years of age; in that case, the Undertaking shall be
signed by his/her parent/guardian.

ii) Submission of false Undertaking is punishable offence. If it is found at any stage that false
Undertaking was submitted, admission shall be cancelled and legal proceedings shall be initiated,
for which candidate/parent/guardian shall be responsible.

ADMISSION BROCHURE 2022-23 185 | P a g e

 Appendix 5

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 2022-23)
(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

ADMISSION BROCHURE 2022-23 186 | P a g e

 Appendix 6

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 2022-23 this certificate
(FOR VARIOUS PROGRAMME)

Name of Candidate: (Mr./Miss/Mrs.) _________________________________________________________________

Father’s/ Guardian’s Name: (Mr./ Shri) ___________________________________________________________________
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/Defence/PWD/Kashmiri Migrant)_____________
CET/ National Level Test Rank ______________ Programme ______________________

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

2. Date of Birth _______________Age as on 1-8-2022: 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 (Yes/No) _____________
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/PWD/Defence/Kashmiri Migrants/Minority Community (Attach photocopy):
10. Character Certificate (Attach photocopy) (Yes/No) _______
11. Medical Certificate (Attach Original) (Yes/No) __________
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) CAT/CMAT/CET Score/Rank ____________________
(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

ADMISSION BROCHURE 2022-23 187 | P a g e

 Appendix 7
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 Programme/Stream
____________________, at (Institute/College)_____________________________have received a copy
of the UGC Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009,
(hereinafter called the “Regulations”) carefully read and fully understood the provisions contained 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

ADMISSION BROCHURE 2022-23 188 | P a g e

 Appendix 8

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 called the “Regulations”), carefully read and fully understood
the provisions contained 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 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

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