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Information Brochure

B.Tech Admission 2018-19

Indian Institute of Technology Tirupati


Renigunta Road, Tirupati – 517 506

1
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506

Dear Student,
Greetings and good wishes to you on behalf of the IIT Tirupati.
We warmly welcome you to IIT Tirupati and congratulate you for gaining admission into one of India’s most
prestigious higher technical Institutions. We wish to make your experience most fulfilling and wonderful
phase in your life.
Schedule of activities:

Date Event Venue


For Boys
Boys Hostel, IIT Tirupati Permanent Campus, Yerpedu –
Venkatagiri Road, Yerpedu (1.5 Kms from Yerpedu Main
Junction). (Route Map)
Reporting for Hostel Contact persons: Mr. Ramesh Krishnan – 8333904912
07-08-2018 Admission Mr. Janakiraman – 8333987911)
For Girls
Girls Hostel, Lakshminagar Colony (Near Temporary Campus),
Renigunta Road, Tirupati – 517 506.
Contact person: Mrs. Pushpalatha - 9502361362
Orientation Program & Academic Building, IIT Tirupati (Permanent Campus),
08-08-2018
Document Verification Yerpedu-Venkatagiri Road.
09-08-2018 to Academic Building, IIT Tirupati (Permanent Campus),
Induction Program
11-08-2018 Yerpedu-Venkatagiri Road.
Academic Building, IIT Tirupati (Permanent Campus),
13-08-2018 Commencement of Classes Yerpedu-Venkatagiri Road.
(Buses will be arranged from Girls hostel to Institute)
The last date for enrolment with fine of Rs. 2000/- is 16-08-2018

Students should produce the following documents in original for verification during Admission on
08.08.2018 (Tuesday):
a) Provisional Admission letter
b) Original Admit Card JEE (Advanced) 2018
c) Original Certificate of Date of Birth, 10th class and 12th class or equivalent
d) If you belong to DS/SC/ST/OBC-NCL category or PwD, the category and/or PwD certificate as per the
format in the JOSAA portal.
e) The students belonging to most economically backward (whose family income is less than Rs. 1.00 lakh
per annum) and other economically backward (whose family income is between Rs.1.00 lakh and
Rs.5.00 lakhs per annum) have to obtain Income certificate in the Form A/B (Annexure III) and apply
for the fee remission in the prescribed Form (Annexure VII) and submit the same in original for
verification at the time of admission i.e., on 08-08-2018 failing which they are not eligible for Tuition
fee concession as indicated in the fee structure.
Students should submit the following at the time of admission:
a) Scholarship application form [MCM Scholarship (Annexure IV A) SC/ST Scholarship (Annexure IV
B)] along with income certificate Form A/B (if eligible).
b) Medical Examination Report (Annexure V) – Test reports not required
c) Solemn Affirmation of conformance to rules and regulations, Anti-ragging Self and Parent declaration
(Annexure VI)
d) Transaction details for online fee payment
e) Student datasheet form (Annexure VIII)

[P.T.O]
2
As you may be aware, English is the sole medium of instruction and examination here, just as it is at other
educational institutions offering professional courses. Students are expected to have a certain level of
proficiency in English so that they can understand lectures, communicate with fellow students and others,
and engage in regular academic pursuits.
To identify students in need of a basic level course in English, and Diagnostic Test will be conducted. This
is a compulsory test for all those joining the B.Tech. Based on their performance, students in need of basic
level English will be identified and given a suitable course in the August - December 2018 semester.
The Diagnostic Test may include tests of grammar, vocabulary, reading and listening comprehension and
related writing such as essays.
Please bring one set of khaki uniform (Pant & Shirt for Boys and Over coat for Girls) and shoes to wear
during workshop practical class.
We look forward meeting you and your parents/guardian at the time of orientation on 08-08-2018.

With best wishes


Prof. K. Krishnaiah
Dean Academic Affairs

3
Annexure I A
Indian Institute of Technology Tirupati
Renigunta Road, Tirupati – 517 506

Fee Structure – B.Tech (2018 Batch)


First Semester (July-Dec 2018)

S.No Item of Fee & Deposits Value in Rs.


I. Institute Fees
Income Income Income
SC/ST/
Above 5 between 1 below 1
PwD
Lakhs to 5 Lakhs Lakh
A. One Time Fees (during admission)
1. Admission fee 150 150 150 150
2. Grade card fee 150 150 150 150
3. Provisional certificate 100 100 100 100
4. Medical Exam fee 100 100 100 100
5. Student welfare fund 1000 1000 1000 1000
6. Modernization fee 300 300 300 300
7. Alumni Life Membership Fee (NS) 1000 1000 1000 1000
8. Publication Fee (NS) 250 250 250 250
Total A 3050 3050 3050 3050
B. Semester Fees
1. Tuition Fee 0 100000 33334 0
2. Examination Fee 350 350 350 350
3. Registration – Enrolment Fee 200 200 200 200
4. Gymkhana Fee 1250 1250 1250 1250
5. Medical Fee 700 700 700 700
6. Student Wellness Fee 100 100 100 100
7. Medical Insurance Premium 1100 1100 1100 1100
8. Hostel Seat Rent * 5000 5000 5000 5000
9. Fan, Electricity & Water charges * 750 750 750 750
Total B 9450 109450 42784 9450
C. Deposits (refundable)
1. Institute Deposit 1000 1000 1000 1000
2. Library Deposit 1000 1000 1000 1000
Total C 2000 2000 2000 2000
Total Institute Fee for Hostellers (A+B+C) 14500 114500 47834 14500
Total Institute Fee for Day-Scholars [A+(B-*)+C+II(3)] 14750 114750 48084 14750
II. Hostel & Mess Charges for GE/OBC/ and SC/ST/PwD
1. Admission Fee 250
2. Hostel Deposit (NS)-(refundable) 3000
3. Estt. “A” Charges 6000
4. Estt. “B” Charges 1500
5. SWD 50
6. Advanced Dinning charges 22750
Total 33550

NS - Non-Statutory fees
* - For Hostellers only

All the students shall have access to interest free loan under Vidyalaxmi scheme

Note: Students who paid more than Institute fees applicable to them as indicated above at the time of seat
Acceptance, need not pay any fee at the time of admission in IIT Tirupati.

Hostel rooms are allotted on sharing basis. If you wish to be a dayscholar, you should register your
name in the Office of the Associate Dean Students and obtain dayscholar certificate immediately after
admission.

4
Annexure I B

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


Renigunta Road, Tirupati – 517 506

Details of fee payable various categories of students

Institute Fee
Hostel
S.No Fee Particulars Hosteller Day Scholar Fee Due
Total Due Total Due
(1) (2) (3) (4) (5) (6) (7)
1 SC/ST/PwD Students 14500 1000 14750 1250 33550

Most economically backward


2 students (whose family income is 14500 (-) 19000 14750 (-) 18750 33550
less than 1 lakh per annum)

Other economically backward


3 students (whose family income is 47834 14334 48084 14584 33550
1 lakh to 5 lakh per annum)

All other students (whose family


4 114500 81000 114750 81250 33550
income above 5 lakhs per annum)
Seat acceptance fee of Rs.13500/- (SC/ST/PwD) and Rs.33500/- (for others) has already been paid*.
The balance fee to be paid is shown in column number (4) and (6) of above table. Extra payment made
by the students as shown in column number (4) and (6) with minus (-) sign will be credited to the
student’s bank account after admission.

* Rs.1500/- deducted towards processing fee for document verification at reporting centre.

Fees should be paid only through online. DD is not acceptable.


Online payment link: https://www.onlinesbi.com/prelogin/icollecthome.htm?corpID=646389

Note: Candidates can pay the fee online with effect from 16-07-2018 onwards.

5
Annexure II A

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


Renigunta Road, Tirupati – 517 506

Statement of Expenditure for B.Tech Programme


(Students’ whose family income is above 5 lakhs per annum)

The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.

Value in
S.No Particulars
Rs.
1. Admission/1st semester fee (including insurance) 1,12,500
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 1,08,350 x 7 7,58,450
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 12,16,950
13. Semester abroad programmes** 4,00,000
Grand Total 16,16,950

* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.

** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean Academic Affairs in these cases. Student may be permitted
to avail this additional loan provision with the production of: (i) Letter of permission from host University
and (ii) Letter of permission from the respective Dean Academic Affairs of IIT Tirupati.

Academic Section

6
Annexure II B

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


Renigunta Road, Tirupati – 517 506

Statement of Expenditure for B.Tech Programme


(Students’ whose family income between Rs.1 Lakh to Rs.5 Lakhs per annum)

The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.

Value in
S.No Particulars
Rs.
1. Admission/1st semester fee (including insurance) 45,834
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 41,684 x 7 2,91,788
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 6,83,622
13. Semester abroad programmes** 4,00,000
Grand Total 10,83,622

* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.

** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean Academic Affairs in these cases. Student may be permitted
to avail this additional loan provision with the production of: (i) Letter of permission from host University
and (ii) Letter of permission from the respective Dean Academic Affairs of IIT Tirupati.

Academic Section

7
Annexure II C

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


Renigunta Road, Tirupati – 517 506

Statement of Expenditure for B.Tech Programme


(Students’ whose family income is below Rs.1 Lakh per annum)

The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.

Value in
S.No Particulars
Rs.
1. Admission/1st semester fee (including insurance) 12,500
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 8,350 x 7 58,450
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 4,16,950
13. Semester abroad programmes** 4,00,000
Grand Total 8,16,950

* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.

** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean Academic Affairs in these cases. Student may be permitted
to avail this additional loan provision with the production of: (i) Letter of permission from host University
and (ii) Letter of permission from the respective Dean Academic Affairs of IIT Tirupati.

Academic Section

8
Annexure II D

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


Renigunta Road, Tirupati – 517 506

Statement of Expenditure for B.Tech Programme


(All SC, ST, PwD students’ irrespective of parental Income)

The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.

Value in
S.No Particulars
Rs.
1. Admission/1st semester fee (including insurance) 12,500
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 8,350 x 7 58,450
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 4,16,950
13. Semester abroad programmes** 4,00,000
Grand Total 8,16,950

* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.

** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean Academic Affairs in these cases. Student may be permitted
to avail this additional loan provision with the production of: (i) Letter of permission from host University
and (ii) Letter of permission from the respective Dean Academic Affairs of IIT Tirupati.

Academic Section

9
Annexure III

FORM A

INCOME CERTIFICATE FROM THE HEAD OF THE OFFICE WHERE


FATHER AND/ OR MOTHER /GUARDIAN OF THE STUDENT IS EMPLOYED

(This certificate is to be produced by Father /Mother /Guardian who are working in


Government/ Public sector organisation.)

Certified that the annual income of Shri / Smt. _____________________________________


(Father / Mother / Guardian) employed in this office as ______________________________
including special pay, etc. during the year 2017-2018 (July 2017–June 2018) is as given below:

Total in
Sl. No. Item
(July 2017 to June 2018)
1 Basic Pay (including special pay, NPA etc.)

2 D.A.

3 C.C.A.

4 Deputation allowance

5 Special Pay

6 Honorarium

7 Bonus

8 Other allowances, if any


Total

Place : Signature of the Head Office / Department


Date :

(This certificate is not valid without the office seal)


Note: Separate certificate has to be given for father & mother
(if father and mother are employed)

10
FORM B

INCOME CERTIFICATE FROM THE REVENUE OFFICIAL NOT BELOW THE


RANK OF THASILDAR OR MAGISTRATE CLASS I OF THE AREA WHERE THE
FATHER AND/OR MOTHER/LEGAL GUARDIAN OF THE STUDENT RESIDES

(This certificate is to be produced by Father /Mother /Guardian who are self-employed as


Doctor/ Lawyer/Businessman/Agriculturist/Private employment, etc.)

Certified after having fully satisfied myself that the income of


Shri/Smt._________________________________________ Father/ Mother/ Guardian of the
student residing at ___________________________________________________________
______________________________is ______________ for the period from July 2017 to
June 2018 as detailed below:

Total Annual Income in `.


Sl.No. Item
(July 2017 to June 2018)
1 Professional Income (Doctor, Lawyer, etc.)

2 Agricultural Income

3 Interest from Bank deposits

4 Dividend from shares

Other income (give details such as House rent


5
income etc.)
Total

Signature of Father :

Mother :

Date : Signature of the Revenue Official


Not below the rank of Tahsildar/ Magistrate Class I
Place :

(This certificate is not valid without the official seal)


Note : Separate certificate has to be given for father and mother if both have separate
sources of income.

11
Annexure IV A

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


APPLICATION FORM FOR MCM SCHOLARSHIP

(This form is to be filled in by B.Tech students whose parents’ annual income is less than
Rs.4.50 lakhs during July 2017 to June 2018)

1. Name of the student (in block letters) :

Roll No. :

Hostel Address :
(If day scholar, give present address)

2. Category : GE / OBC / PD-GE/ PD-OBC


(enclose copy of certificates if any)

3. Date of Birth :

4. Place, District and State of birth :

5. Permanent address :

6. Parent’s Occupation (Please tick whichever is applicable)

Sl.No Job Father Mother Guardian


1 Govt. job /
Company job

2 Self-employment :
Lawyer/Doctor/
Business/
Agriculture, etc.

Parent’s Mobile No. :

Student Mobile No & e-mail ID :

Contd….

12
- 2-

7. Income in Rupees:

Sl.No Income thro’ Father Mother Guardian


1 Salary/Pension

2 Self-employment:
Profession/
Business/
Agriculture/
Others (specify)

3 Other Income:
Rent/Interest on
Investment, etc.

The above income must be authenticated as follows:


• Salary/Pension – Employer’s certificate in Form A has to be given (If father and
Mother are employed, two separate certificate have to be given)
• Agriculture / House Income / Business/Consultancy / Doctor / Lawyer /
Professional Practice – Thasildar’s certificate in Form B has to be given

8. Have you applied for (or) getting any other Scholarship : Yes / No

If yes, from which Organisation ? :

What is the amount per annum : `.

We hereby declare and affirm that the above statement made by us is correct to the best
of our knowledge. In case any of the particulars furnished by us are found to be
incorrect at a later date, we will be liable to refund the scholarship amount already
received.

(Signature of the Parent) (Signature of the Student)

Place :
Date :

STUDENT UNDERTAKING

Certified that Shri/Ms Roll No. ------------------


is not in receipt of Scholarship from any other sources.

Date
Signature
Name :
Hostel & Room No :

13
FORM A

INCOME CERTIFICATE FROM THE HEAD OF THE OFFICE WHERE


FATHER AND/ OR MOTHER /GUARDIAN OF THE STUDENT IS EMPLOYED

(This certificate is to be produced by Father /Mother /Guardian who are working in


Government/ Public sector organisation.)

Certified that the annual income of Shri / Smt. _____________________________________


(Father / Mother / Guardian) employed in this office as ______________________________
including special pay, etc. during the year 2017-2018 (July 2017–June 2018) is as given below:

Total in
Sl. No. Item
(July 2017 to June 2018)
1 Basic Pay (including special pay, NPA etc.)

2 D.A.

3 C.C.A.

4 Deputation allowance

5 Special Pay

6 Honorarium

7 Bonus

8 Other allowances, if any


Total

Place : Signature of the Head Office / Department


Date :

(This certificate is not valid without the office seal)


Note: Separate certificate has to be given for father & mother
(if father and mother are employed)

14
FORM B

INCOME CERTIFICATE FROM THE REVENUE OFFICIAL NOT BELOW THE


RANK OF THASILDAR OR MAGISTRATE CLASS I OF THE AREA WHERE THE
FATHER AND/OR MOTHER/LEGAL GUARDIAN OF THE STUDENT RESIDES

(This certificate is to be produced by Father /Mother /Guardian who are self-employed as


Doctor/ Lawyer/Businessman/Agriculturist/Private employment, etc.)

Certified after having fully satisfied myself that the income of


Shri/Smt._________________________________________ Father/ Mother/ Guardian of the
student residing at ___________________________________________________________
______________________________is ______________ for the period from July 2017 to
June 2018 as detailed below:

Total Annual Income in `.


Sl.No. Item
(July 2017 to June 2018)
1 Professional Income (Doctor, Lawyer, etc.)

2 Agricultural Income

3 Interest from Bank deposits

4 Dividend from shares

Other income (give details such as House rent


5
income etc.)
Total

Signature of Father :

Mother :

Date : Signature of the Revenue Official


Not below the rank of Tahsildar/ Magistrate Class I
Place :

(This certificate is not valid without the official seal)


Note : Separate certificate has to be given for father and mother if both have separate
sources of income.

15
Annexure IV B

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


APPLICATION FORM FOR SC/ST SCHOLARSHIP

(This form is to be filled in by B.Tech students whose parents’ annual income is less than
Rs.4.50 lakhs during July 2017 to June 2018)

1. Name of the student (in block letters) :

Roll No. :

Hostel Address :
(If day scholar, give present address)

2. Category : SC / ST / PD-SC/ PD-ST


(enclose copy of certificates if any)

3. Date of Birth :

4. Place, District and State of birth :

5. Permanent address :

6. Parent’s Occupation (Please tick whichever is applicable)

Sl.No Job Father Mother Guardian


1 Govt. job /
Company job

2 Self-employment :
Lawyer/Doctor/
Business/
Agriculture, etc.

Parent’s Mobile No. :

Student Mobile No & e-mail ID :

Contd….

16
- 2-

7. Income in Rupees:

Sl.No Income thro’ Father Mother Guardian


1 Salary/Pension

2 Self-employment:
Profession/
Business/
Agriculture/
Others (specify)

3 Other Income:
Rent/Interest on
Investment, etc.

The above income must be authenticated as follows:


• Salary/Pension – Employer’s certificate in Form A has to be given (If father and
Mother are employed, two separate certificate have to be given)
• Agriculture / House Income / Business/Consultancy / Doctor / Lawyer /
Professional Practice – Thasildar’s certificate in Form B has to be given

8. Have you applied for (or) getting any other Scholarship : Yes / No

If yes, from which Organisation ? :

What is the amount per annum : `.

We hereby declare and affirm that the above statement made by us is correct to the best
of our knowledge. In case any of the particulars furnished by us are found to be
incorrect at a later date, we will be liable to refund the scholarship amount already
received.

(Signature of the Parent) (Signature of the student)

Place :
Date :

STUDENT UNDERTAKING

Certified that Shri/Ms. Roll No. ------------------


is not in receipt of Scholarship from any other sources.

Date
Signature :
Name :
Hostel & Room No :

17
FORM A

INCOME CERTIFICATE FROM THE HEAD OF THE OFFICE WHERE


FATHER AND/ OR MOTHER /GUARDIAN OF THE STUDENT IS EMPLOYED

(This certificate is to be produced by Father /Mother /Guardian who are working in


Government/ Public sector organisation.)

Certified that the annual income of Shri / Smt. _____________________________________


(Father / Mother / Guardian) employed in this office as ______________________________
including special pay, etc. during the year 2017-2018 (July 2017–June 2018) is as given below:

Total in
Sl. No. Item
(July 2017 to June 2018)
1 Basic Pay (including special pay, NPA etc.)

2 D.A.

3 C.C.A.

4 Deputation allowance

5 Special Pay

6 Honorarium

7 Bonus

8 Other allowances, if any


Total

Place : Signature of the Head Office / Department


Date :

(This certificate is not valid without the office seal)


Note: Separate certificate has to be given for father & mother
(if father and mother are employed)

18
FORM B

INCOME CERTIFICATE FROM THE REVENUE OFFICIAL NOT BELOW THE


RANK OF THASILDAR OR MAGISTRATE CLASS I OF THE AREA WHERE THE
FATHER AND/OR MOTHER/LEGAL GUARDIAN OF THE STUDENT RESIDES

(This certificate is to be produced by Father /Mother /Guardian who are self-employed as


Doctor/ Lawyer/Businessman/Agriculturist/Private employment, etc.)

Certified after having fully satisfied myself that the income of


Shri/Smt._________________________________________ Father/ Mother/ Guardian of the
student residing at ___________________________________________________________
______________________________is ______________ for the period from July 2017 to
June 2018 as detailed below:

Total Annual Income in `.


Sl.No. Item
(July 2017 to June 2018)
1 Professional Income (Doctor, Lawyer, etc.)

2 Agricultural Income

3 Interest from Bank deposits

4 Dividend from shares

Other income (give details such as House rent


5
income etc.)
Total

Signature of Father :

Mother :

Date : Signature of the Revenue Official


Not below the rank of Tahsildar/ Magistrate Class I
Place :

(This certificate is not valid without the official seal)


Note : Separate certificate has to be given for father and mother if both have separate
sources of income.

19
Annexure V

CONFIDENTIAL
Medical Examination Report
Medical History and personal particulars of Students joining at IIT Tirupati
1. Full Name (in capitals) …………………………………………………..………………………
2. JEE (Adv) 2018 Roll No. …………………………… IITT Roll No.……..…………………
3. Name of Parent/Guardian ………………………………………………………………………..
4. Personal : Veg. / Non-Veg.
Abuse of substances (if any) : Smoking / Alcohol / Drugs / Any other
5. Past Medical/Surgical Treatment : No Yes

5.1 Allergies/Bronchial Asthma/Tuberculosis


5.2 Abdomen including Urinary Tract
5.3 Locomotor system (Spinal/Vertebral column/Joints)
5.4 Cardiovascular system
5.5 Neurological disorders/Psychological disorders
5.6 Sexually-transmitted/Venereal Diseases/Skin
5.7 Hepatitis
5.8 Diabetes
5.9 Rheumatism
5.10 Thyroid disease

6. Family history of any major illness : No Yes


6.1 Tuberculosis
6.2 Leprosy
6.3 Diabetes
6.4 Hypertension
6.5 Ischemic heart diseases
6.6 Psychiatric illness
6.7 Cancer
7. Identification marks : 1)

2)

8. Blood Group :

I declare that all the statements above are true and correct to the best of my knowledge. I fully
understand that I am responsible for the accuracy of all statements given.

Candidate’s Signature : ………………………………………………………………………….

Counter signed by Parent/Guardian………………………………………………………………….

Date :

Place : P.T.O. (2)

20
:2:

HEALTH CERTFICATE

1. Examination by a General Physician (M.D. in General Medicine)

I, Dr. ……………………………………………………………………………………………………
after examining (with necessary investigations) Mr./Ms. ……………………………………………
Son / Daughter of Mr./Ms. ……………………………………………………………………………….
born on …………………………

CERTIFY:

Weight ………. Kg. Height ………. cm. Blood Pressure ………….. /…………. mm Hg.

Girth of Chest : (a) At rest ……………………. : (b) After deep inspiration ………………………..

Cardiovascular System : Heart ………………… Heart Sounds ……………

Respiratory System :

Neurological System :

Psychological disturbance : Yes / No If yes, specify


………………………………….

Past Medical or Surgical Record :

Identified allergies :

Current treatments :

Current vaccination Status (All candidates who do not have adequate active/passive immunity against
diseases mentioned below should take these injections/adult booster dose as recommended, just before
joining the Institute and the date to be mentioned below):

VACCINATION AGAINST 1st Injection Last Booster


DISEASES Date Yes / No Date Yes / No
BCG
Diphtheria – Tetanus - Poliomyelitis
Measles, Mumps, Rubella
Hepatitis B
Hepatitis A
Meningitis
Typhoid
Chicken Pox
Influenza Vaccine (H1N1)

Candidate’s Signature : …………………………………………………………….

P.T.O. (3)

21
:3:
INVESTIGATIONS

1. *Electrocardiogram Date ……………………….. Result ………………………

2. *Chest X-ray Date ……………………….. Result ………………………

3. *Sonography (whole abdomen) Date ……………………….. Result ………………………

4. *Urine Date ………………………. Result ………………………

5. *Blood Tests Date ……………………….. Result ………………………

a) Blood Sugar (F/PP) Date ……………………….. Result ………………………

b) Urea/Creatinine Date ……………………….. Result ………………………

c) Peripheral Smear Study/HB% Date ……………………….. Result ………………………

d) Lipid Profile Date ……………………….. Result ………………………

e) Blood Group/typing (if not known) Date ……………………….. Result ………………………

f) HBS Ag Date ……………………….. Result ………………………

g) HIV – I & II Date …………………….. Result ………………………

*All original investigation reports (only) to be attached.

Remarks / Special Recommendation, if any:

Conclusion : 1. Fit / Unfit to pursue higher education with a very tight academic schedule.
2. Does not suffer from any seizure disorder and he/she is fit for swimming

Reason :

Date :

Place : Signature & Seal

Candidate’s Signature : …………………………………………………………………………….

P.T.O. (4)

22
:4:
2. Examination by Ophthalmologist*

Acuity of Far Vision Near Vision Colour Vision


Vision Naked Eye With Glasses Naked Eye With Glasses
R.E.

L.E.

*Latest Optometrist’s Recommendations, if any to be attached in original.

Remarks / Special Recommendation, if any :

I, Dr. …….……………………………………………………………………………………………..
have examined (with necessary investigations) Mr./Ms. ……………………………………………
Son / Daughter of Mr./Ms. ……..……………………………………………………….………….
born on ……………………………… and the above information given to the best of my knowledge
are correct and true.

Date :

Place : Signature & Seal

3. Examination by ENT Specialist*

Inspection / hearing *Audiometry


Right Ear
Left Ear

*Latest Audiometry report to be attached in original.

Remarks / Special Recommendations, if any.

I, Dr. …….……………………………………………………………………………………….. have


examined (with necessary investigations) Mr./Ms. ………………...…………………………………
Son / Daughter of Mr./Ms. ……..…………………………………………………..…….…………….
born on ……………………………… and the above information given to the best of my knowledge
are correct and true.

Date :

Place : Signature & Seal

Candidate’s Signature : ………………………………………………………………………

23
Annexure VI

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


SOLEMN AFFIRMATION OF CONFORMANCE TO RULES AND REGULATIONS
(to be submitted by all Students / Scholars of IIT Tirupati)
(TO BE FILLED ALL IN CAPITAL LETTERS)

I, Mr./Ms………………………………………………………………………………………………,

assigned with IIT Tirupati Roll No…………………………………….., am the son/daughter/ward of

Mr./Ms. ……………….………………….……………………………………………………………,

Residing at Door No. ………………………………House No……..……..……………….………….,

Street Name: . ……………………………………………………....……………………...……………,

Local Area Name: . ………………………………………………………………..……………………,

Village/Town/City Name: .……………………………………………………………………….……..,

State: . ……………………………………………………… . Pin code:………………………..……,

am joining as a student of …………………… Programme in Department of ……………….………..,

………………………………………………………

I hereby declare that, I:


a) have read and understood the prevailing rules of regulations of the Institute
b) am aware of
(i) The national laws pertaining to ragging,
(ii) The serious consequences of this impermissible behavior, and
(iii) The administrative, legal and penal actions that will be imposed on persons apprehended,
tried and convicted of this crime; and
c) am aware of the ban on the possession and/or use of alcohol or tobacco in any form and any
powered vehicles by students inside the IIT Tirupati Campus.
Keeping the above in mind, I SOLEMNLY AFFIRM that:
a) I SHALL NOT violate the prevailing rules and regulations of IIT Tirupati, 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 alcohol or tobacco product and powered vehicle inside the
IIT Tirupati campus, except with the due permission, if applicable, and that

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

Signature of Student Counter Signed by Parent/Guardian

Place: Tirupati
Date:

Please visit http://iittp.ac.in/images/demo/iit/pdfs/B.Tech-Ordinance-Regulations.pdf


24
SELF DECLARATION BY THE STUDENT

1) I, ________________________________________________________
_______________________________________________ (Full name of student in CAPITAL letters with
roll number) S/o D/o Shri./ Smt. ___________________________________________
___________________________________________________________ having been admitted to Indian
Institute of Technology Tirupati, have:
(a) Been advised to read carefully and understand the Supreme Court Judgement on Ragging hosted
in http://iittp.ac.in/anti-ragging/
(b) Received a copy of the Essential Extracts of relevant Regulations on Curbing the Menace of
Ragging in Higher Educational Institutions, 2009, (hereinafter called the relevant Regulation)
(c) Carefully read and fully understood the provisions contained therein.
2) I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what constitutes ragging
and the implications thereof.
3) I have also, in particular, understood Clause 7 and Clause 9.1 of the relevant Regulations and am fully aware of
the penal and administrative actions that are 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 state and undertake that:
a) I will not indulge in any behavior or act that may be considered as ragging under Clause 3 of the
relevant Regulations.
b) I will not participate in or abet or propagate through any act of commission or omission that may be
considered as ragging under Clause 3 of the relevant Regulations.
5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to Clause 9.1 of the relevant
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 this declaration is found to be untrue, I am aware that my admission is liable to be cancelled.
Place:

Date:
Signature of Student
Name: Telephone/Mobile No:

Address:
SELF-DECLARATION
Verified that the contents of this self declaration are true to the best of my knowledge and no part of the declaration
is false and nothing has been concealed or misstated therein.
Place:
Date: Signature of Student

25
SELF DECLARATION BY PARENTS/GUARDIANS
1) I, Mr./Mrs./Ms. _______________________
_________________ (Titles, Full name of Parents/Guardians in CAPITAL letters)
Father / Mother / Guardian of Mr. / Ms. ___________________________________________________
________________________________________________ (Full name of student in CAPITAL letters
with Roll number) who has been admitted to Indian Institute of Technology Tirupati have:

(a) Been advised to read carefully and understand the Supreme Court Judgement on Ragging hosted
in http://iittp.ac.in/anti-ragging/
(b) Received a copy of the Essential Extracts of relevant Regulations on curbing the Menace of
Ragging in Higher Educational Institutions, 2009, (hereinafter called the relevant Regulations)
(c) Carefully read and fully understood the provisions contained there-in.
2) I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what constitutes
ragging and the implications thereof.
3) I have also, in particular, understood Clause 7 and Clause 9.1 of the relevant Regulations and am fully
aware of the penal and administrative actions that are 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 state and undertake that:
a) My ward will not indulge in any behavior or act that may be considered as ragging under Clause 3
of the relevant Regulations.
b) My ward will not participate in or abet or propagate through any act of commission or omission
that may be considered as ragging under Clause 3 of the relevant Regulations.
5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to Clause 9.1 of
the relevant 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 this declaration is found to be untrue, my ward’s admission is liable to be
cancelled.

Name:
Address: Signature of Father/Mother/Guardian
Telephone / Mobile No.

SELF DECLARATION by PARENTS/GUARDIAN


Verified that the contents of this self declaration are true to the best of my knowledge and no part of the self
declaration is false and nothing has been concealed or misstated therein.

Place: Signature of Father/Mother/Guardian


Date:

26
Annexure VII

To
The Registrar
IIT Tirupati

Sir,
Sub: Application for Remission of Fee
(For those students whose parental income is less than Rs. 5 (Five) lakhs per annum)

This is to inform you that my family income from all source is Rs. ______________ / (in words Rupees
_____________________________________________) for the financial year 2017-18. In support of
my claim Form-A along with a copy of IT Return for the assement year 2017-18 is enclosed.
OR
I am not required to file IT return in accordance with Income Tax Act 1961, therefore I am enclosing
Income certificate in Form - B issued in the last six months by the Revenue Officer.
---------------------------------------------------------------------------------------------------------------------------
(strike out which is not applicable)

I further declare that the above information is true to the best of my knowledge and belief and I am
aware that I am solely responsible for the correctness and accuracy of the above declaration and
understand that providing false information amounts to miscounduct and may lead to cancellation of
admission at IIT Tirupati. I further authorize IIT Tirupati to verify my income.
Accordingly, I request you to kindly exempt me from paying tuition Fee as indicated below.
(1) Rs. 1,00,000/- (Family Income less than Rs. 1,00,000/- per annum.)
(2) Rs. 66,666/- (Family Income less between Rs. 1,00,000/- and Rs. 5,00,000/-)
---------------------------------------------------------------------------------------------------------------------------
(strike out which is not applicable)

Student’s Signature : ___________________ Parent’s Signature : ___________________

Name : ___________________ Name : ___________________

Roll No. : ___________________ Address : ___________________

Department : ___________________ : ___________________

Address : ___________________ PAN : ___________________

: ___________________ UID : ___________________

PAN : ___________________ Bank A/C No : ___________________

UID : ___________________ Date : ___________________

Bank A/C No : ___________________ Place : ___________________

Date : ___________________

Place : ___________________

27
Annexure VIII

INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI


Renigunta Road, Tirupati – 517 506

Students’ Datasheet
Department: Roll No:
(Please fill this at the time of admission)
(Affix recent passport
size photo here)

Date of Joining:

A. PERSONAL INFORMATION:

JEE (Adv) Registration No: All India Rank:

1. Full Name (in Block letters as per


JEE Allotment letter)
(All Certificates, Grade Cards &
Transcript will be issued in this name
only)

2.Date of Birth (DD/MM/YYY) 3. Gender (M/F) 4. Blood Group 5. Height (Cm)

6. Weight (Kg) 7. Nationality 8. Category(Gen/OBC/SC/ST/PwD)

9. BPL Category (If yes, supporting documents) 10. Religion

11. State of Domicile 12. Mother Tongue

13. ID Marks 14. Presently reside at (Hostel address to be filled after admission)

15. Bank details: a. Name of Bank b. Branch c. A/c No d. IFSC

16. Mobile No: 17. Passport No: 18. E-mail Id:

19. Aadhaar No (photocopy to be attached):

20. EDUCATIONAL INFORMATION:

Examination Passed Medium of Board / University Year of Division/ % of Marks /


Discipline
(All Preceding Examinations) Instruction / Institute passing Class CGPA

HSC (10 Level) or Equivalent

H.S. (10+2 Level) or Equivalent

28
B. PARENTAL INFORMATION:
Phone No.(with STD code) Mob e-mail id
21. Father’s Name
(full name in block letters)

22. Mother’s Name


(full name in block letters)

23. Guardian
(full name in block letters)

Father Mother Guardian

24. Occupation

25. Income (Income Certificate to be


attached)
C. RESIDENTIAL INFORMAION:

26. Present Address for Communication 27. Permanent Address

State: Pin: State: Pin:

I do hereby declare that the information furnished by me is true to best of my knowledge, belief & based on records

Signature of the Student :

Date :

Name of Parent/Guardian :

Signature of the Parent/Guardian :

Date :

29

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