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Indian Institute of Technology Madras M.Tech. Admission for Academic Year 2014-2015

Form for Reporting for Admission and Request for Updation

Name of the Candidate:

M.Tech. Application No.:

Programme Offered:

Roll No.:

I hereby report to attend the Admission for M.Tech. programme at IIT Madras for the academic year 2014-2015 scheduled on 21 st July, 2014 (Monday).

I wish to be considered for updating to programme(s) of my higher preference(s) indicated in my application, if vacancy arises. I understand that it is mandatory

that I should take the discipline and stream allotted to me as a result of updating.

(Strike out the above paragraph, if you do NOT want updation. The updation is NOT applicable for the candidates who have got the offer of admission to programmes of their first preference.)

Date: 21 st July, 2014

Signature of the Candidate

Note: The results of updation will be displayed at 5 p.m. on 22 nd July, 2014 (Tuesday) at Student Activities Centre (SAC) and GATE Office.

M.Tech.

M.Tech. Admission

2014

Indian Institute of Technology Madras

CHECK LIST

Roll No.

Indian Institute of Technology Madras CHECK LIST Roll No. 1. Candidate’s Name     2. M.Tech.

1.

Candidate’s Name

   

2.

M.Tech. Appln. No.

 

3. Gender

2. M.Tech. Appln. No.   3. Gender 4. Category 5. PwD Yes No

4. Category

2. M.Tech. Appln. No.   3. Gender 4. Category 5. PwD Yes No

5. PwD

Yes No
Yes
No

6.

Date of Birth

 

7. Nationality

   

8.

Married

Unmarried

9.

Blood Group Rh

+ -
+
-

(Tick + or – as the case may be)

Example

+ A -
+
A
-
 

10. Programme

(allotted)

Code

Code Programme Name

Programme Name

Code Programme Name
11. Permanent Address: PIN Code Phone No. with STD Code Mobile No.
11. Permanent Address:
PIN Code
Phone No. with STD Code
Mobile No.
Local address (Guardian, if any) Guardian’s Name: PIN Code Phone No. with STD Code Mobile
Local address (Guardian, if any) Guardian’s Name:
PIN Code
Phone No. with STD Code
Mobile No.

12. Documents to be produced (Original and attested copies – original to be returned after verification). Please arrange these in the following order:

S.No

 

Details

Yes

No

Remarks

(i)

First page of SSLC/SSC/Matriculation

     

(ii)

Birth Certificate

     

(iii)

Degree/Provisional certificate

       

Grade cards/Mark sheets of all the semesters/Consolidated Mark list

     

(iv)

Declaration signed by parent/guardian

     

(v)

Medical fitness certificate

       

(vi)

Course completion certificate

       

(vii)

If currently employed, relieving order from the employer

     

(viii)

Community Certificate

       

For SC / ST :

(i)

SC/ST Certificate

For OBC

: (ii) OBC (Non Creamy Layer) Certificate

(ix)

Person with Disability (PwD) certificate, if applicable

     

(x)

Original GATE Scorecard (if not submitted already)

     

(xi)

Details of Fee paid

       

(xii)

“Solemn Affirmation of Conformance to Rules and Regulations” Form

     

13.

Hostel Name & Room No.

 

14. Email ID

 

Date:

Signature of candidate

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Verified & found correct Original GATE Scorecard Stamped

Assistant

For Office use only

Assistant Registrar (Academic)

INDIAN INSTITUTE OF TECHNOLOGY MADRAS Office of Dean (Students)

SOLEMN AFFIRMATION OF CONFORMANCE TO RULES AND REGULATIONS (to be submitted by all Student of I IT Madras)

I, Mr. / Ms

Assigned with Roll No

Mr. /Ms

(all capital letters)

, am the son/daughter/ward of

(all capital letters)

residing at Door No

House No (all capital letters)

Street Name:

 

(all capital letters)

Local Area Name:

Village/Town/City Name:

State:

(all capital letters)

(all capital letters)

(all capital letters)

PIN Code: ------------------

am joining as a student in the Department of-----------------------------------------------------------

I hereby declare that, I:

a) have read and understood the prevailing rules and regulations of the Institute 1 and the Hostel Management 2 ;

b) am aware of (i) the national laws pertaining to ragging, (ii) the serious consequences of involvement in ragging, and (iii) the administrative, legal and penal actions that will be imposed on persons apprehended, tried and convicted of these acts; and

c) am aware of the ban on the possession and/or use of any powered vehicles by students inside the IIT Madras Campus.

Keeping the above in mind, I SOLEMNLY AFFIRM that:

a) I SHALL sincerely obey the prevailing rules and regulations of IIT Madras, 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 powered vehicle inside the IIT Madras campus, except with the due permission, if applicable;

d) I SHALL NOT possess any banned substances / materials during my entire stay at IIT Madras premises; and that

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

Signature of the Student

Place: IIT Madras Date:

Counter signed by Parent / Guardian