AMITY UNIVERSITY

4109

Enrollment Confirmation Form

Declaration by the Student

Form No :5672114

I ___________________________________________________________________ Amity Registration Number

______________________________________________________ accept the offer of admission to the program
___________________________________ of Amity with all terms and conditions as laid down by the Institution.
I shall also abide by all the rules and regulations of the Institution.
Undertaking
I hereby certify that neither I nor anyone on my behalf has paid any Donation/Capitation Fees or done any
favour to anyone for getting my Admission in Amity University Uttar Pradesh. I am aware of the likely presence
of unscrupulous elements like agents and middlemen in the environment. I have not paid any heed to their
solicitations/design.

I further undertake that(Tick the appropriate box):

-

No person has ever demanded any amount/favour

True

False

No person has been given any amount/favour

True

False

and/or

For securing admission to the course applied in Amity, apart from fees and dues of the institute. In case the
answer to the any of the above is false, please give details of that person.
Name

Contact Address

Tel. / Mobile

_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________

In case my declaration is found incorrect at any stage, Amity would be entitled to cancel my admission and
declare my degree/certificate invalid.
Signature
Date

: ____________________________________

: ______ / _______ / _________

Declaration by the Parent/Guardian

I ____________________________ Father/Guardian of __________________________ do hereby accept all

the Terms and Conditions prescribed by the Institution. I further declare that I shall be jointly and severally liable
for any breach of conditions so specified. I further confirm the above declaration and undertaking given by my
ward.

Signature : ________________________________________
Date

: _____ / ______ / __________