I, Mr./Ms. ____________________________________________, Registration. No. _________________, Roll No.
______________________________, Son/Daughter of Mr./Mrs. ________________________________________ do hereby solemnly state & affirm as under:-
1. That I have passed _______________ class in the year _________________ from
______________________________________________ School/College/Institute/University. 2. I got admission in _____________________________________________(Name of the Institute/University) in the Year _________________ in the Department of ______________________________________ to pursue _______________________ Programme of _______________________ Years (Duration of course).
3. I declared that during the GAP Year/s of _________________ to __________________ ,
(tick any one) (a) I did not take admission in any educational institute/college/school/university to pursue further studies after passing ______________________ (Last qualifying examination). (b) I took admission in an educational institute/college/school/university namely _________________________________________________________________________ to pursue _____________________________________________ course after passing qualifying exam from ___________________ to _______________________ and did not avail any Government Scholarship/Financial Assistance.
(c) I took admission in an educational institute/college/school/university namely
_________________________________________________________________________ to pursue _____________________________________________ course after passing qualifying exam from ___________________ to _______________________ and availed Government Scholarship/Financial Assistance from ___________________________________________ (Department) for an amount of Rs. _______________________ .
4. All above information furnished by me are true and genuine.
_______________________________ _____________________________ (Name of the Student) (Name of the Parent)
_______________________________ _____________________________ (Signature of the Student) (Signature of the Parent)
Verification:- Verified that the contents of the above said declaration supported by the document(s) submitted on ________________ by the student are true and correct to the best of my knowledge and belief and nothing has been concealed or misrepresented therein. Date:- _____/________/_______
