(Format For Medical Certificate)

Certificate
(To be completed and signed by a registered MBBS Doctor and presented by the candidate at the time of Admission)

Certified that I have in general and also in regard to following infections, diseases, examined
Mr./Ms.______________________________________ (whose signature is given below) Son/ Daughter of
Sh. _________________________________Resident of ________________________________

Diseases Finding

a) Infectious Skin Diseases

b) Psoriasis Foliate
c) Tuberculosis
d) Trachoma
e) Venereal Diseases
f) HIV

and find that he/she is not suffering form any of above diseases

I also certify that after examination I find that Mr. / Ms. __________________________ is fit to undergo
course of study in Institute of Hotel Management Catering Technology & Applied Nutrition Bathinda.

___________________ __________________
(Signature of Candidate) (Signature of Registered Medical Officer)
Practitioner)

Seal________________

Registration No. __________________

 (The below Undertaking has to be submitted on Rs 10/- stamp paper)

Undertaking by Students and Parents for Rules and Regulations

I, Mr/Ms. _____________________________ Council Roll No. ______________

Ignou Roll No. ____________________ Resident of
___________________________________________________________________
___________________________________________________________________
________________________________________________________________

Joining for the Course _________ Academic batch __________ in Institute of Hotel Management Catering
Technology & Applied Nutrition Bathinda
I am well aware of NCHMCT rules of having minimum 75% aggregate attendance and 40% in
individual subjects to be eligible to appear in the Semester exam.

1. I will attend all the classes from the opening day of the Institute and I will be
regular and punctual to all the classes i.e (Theory/Practical) and am aware that if I
don’t secure attendance more than 75% I shall be detained and not allowed to
appear for the Term End Examination.
2. I will follow the dress code and uniform prescribed by the Institute.
3. Absenteeism on medical grounds is to be informed to the Institute authority by
the parents/guardians of their ward immediately with a medical and fitness
certificate.
4. Any change in address or phone number will be communicated to the
Institute authorities immediately.
………………………………………………………………………………………

Signature of Student

ACKNOWLEDGEMENT
I have gone through carefully the terms of the above undertaking and understand that if
He/She fails to comply with the attendance rules he/she will be detained and will not be
allowed to sit for the Term End Examination.
I undertake that I/he/she will strictly follow the above terms.

Signature of Parent/Guardian

_______________________________
_______________________________
Date: Name & Address with Mobile Number
 ANNEXURE I
AFFIDAVIT BY THE STUDENT

I, _______________________Enrolment number ___________________________ s/o d/o Mr./Mrs./Ms.

___________________________________________ , having been admitted to the institute of Hotel
Management, Bathinda , have received a copy 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.

5. I have, in particular, perused clause 3 of the Regulations and am aware as to what constitutes ragging.

6. I have also, in particular, perused clause 7 and clause 9.1 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.

7. 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:

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 _________ (Place) on
this the (day) __________ of _________ (Month) , _______(year ) .

________________
Signature of deponent
Solemnly affirmed and signed in my presence on this the ___________ (day) of _________(month) ,
_________(year ) after reading the contents of this affidavit.

OATH COMMISSIONER
 ANNEXURE II
AFFIDAVIT BY PARENT/GUARDIAN

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 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 7 and clause 9.1 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 behaviour 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
(place)____________ on this the (day)_____________of (month)____________, (year)__________

________________
Signature of deponent
Solemnly affirmed and signed in my presence on this the (day)__________ of
(month)_____________ (year )__________ after reading the contents of this affidavit.

OATH COMMISSIONER
 FORM OF INDEMNITY BOND

In consideration of my ward being admitted to the Institute of Hotel Management,

Bathinda and or admitted to the hostel as a student/hosteller, for doing the
Course__________________________________________ which involves Training activities in I.H.M.
Campus/outside and travelling, I undertake and agree that neither I nor my executors/administrator or
other representatives will make any claim against the Govt. of India, Board of Governor's or against the
Institute authorities including any officers/faculty/wardens or against any person in the service of the
Institute, in respect of any loss/ injury to any property/person (including injury resulting into death) due to
any reason whatsoever which I/he/she may suffer while or in consequence of his/her participation in any
of the above activities including during industrial training and I understand that no compensation will be
paid by the Govt. of India, Board of Governor's/ Institute Authority including any officers in service of
the Institute in respect of any such loss or injury (including injury resulting into death) I also agree so as
to bind myself/my executors and administrators and other legal representatives to indemnify the Govt. of
India & Institute authorities including the Board's of Governor's of IHM Bathinda and any other officers
in service of the Institute against any claim which may be made by any third party against them/any of
them, arising out of any act of default on my/his/her part during/in connection with said training/course,
in/outside the institute and travelling by road, rail, air, water or while on student exchange Programme or
while deploying/deployed for industrial training or any other such institute activities organized from time
to time, within/ outside the Institute campus.

Dated : ________________ Signature of Student________________________

Parents/Guardian Signature__________________

Home Address____________________________

________________________________________

________________________________________

Signed in the presence of

Witness No. 1 Witness No. 2

Signature____________________________ Signature________________________

Name & Address _____________________ __ Name & Address _____________________

____________________________________ __________________________________

Contact No.__________________________ Contact No._________________________