CHECKLIST

Name of the Student : Date:

Year and Branch : B.E. / B.Tech./ M.E./ Lateral Entry

Put  mark Hostel College Bus Out Bus

The Following Original Document to be submitted by the student at the time of Admission
Sl.No. Particulars Submitted Not Submitted
1. College Application Form
2. Annexure I
3. Annexure II
4. Annexure III
5. 10th Mark sheet
6. +1 Mark Sheet
7. +2 Mark sheet
8. For Lateral Entry only
a. Consolidated Mark Sheet
b. Provisional Certificate/Diploma Certificate
9. Community Certificate
10. Migration Certificate (If Studied in other State)
11. Transfer Certificate
12. Conduct Certificate
13. Xerox copies of the above Certificates (Each 2 Nos.) +
Aadhar card
14. Physical fitness Certificate
15. Photo Passport size - Student (3 Nos.)
16. Parents Photo (Father Photo 1 No. Mother Photo 1 No.)
17. Transport Application Form
18. Hostel Application Form
The following documents are applicable for Government Quota students only
19. Allotment order
20. First Graduate Certificate
21. First Graduate Concession - Joint Declaration Form
22. Income Certificate
The following Fees is applicable for Management Quota students only

23. Rs. 500- CASH ONLY(For Management Quota Students)

(Association of Management Quota Application)
(For Office use only)

Student Signature Parent Signature Verified by (Staff Name and Signature)

 ANNEXURE 1
AFFIDAVIT BY THE STUDENT

I, ________________________________________________________________________ (full
name of student with admission / registration / enrolment number), S/o – D/o Mr. / Mrs. / Ms.
____________________________________________

1) having been admitted to Sri Eshwar College of Engineering,

Coimbatore have received and download a copy of UGC regulations 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 Regulation 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.
4) 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 (day) ______of (month)_________ (year) _____________

Signature of deponent

Solemnly affirmed and signed in my presence of this the (day) ________ of month ________ (year)
_________ after reading the contents of this affidavit.

NOTARY PUBLIC
 ANNEXURE 2
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 numer),

1) having been admitted to Sri Eshwar College of Engineering, Coimbatore have

received a copy of the UGC regulations 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 behavior 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 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, I am aware that 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) and ________ (year)

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

NOTARY PUBLIC
 Annexure III
DECLARATION FORM

I hereby solemnly and sincerely affirm :

1. That the statements made and information furnished in my son's / daughter's / ward's application as
also in all the enclosures thereto submitted by him / her are true. Should it however, be found that any
information furnished therein is untrue in material particulars. I realise that I am liable to criminal
prosecution and I also agree to the forfeiture of the seat in the institution.
2. That I have read the eligibility regulations and am satisfied that my ward is for admission to the course,
as per University, Government norms.
3. That my son / daughter /ward would confirm strictly to all the rules and regulations in for or which
may be introduced in the institution hereafter and that I realise that breach of discipline and rules on my
son's/daughter's/ ward's part would entail summarily forfeiture of his /her seat in the institution.
4. That I am aware that if my son / daughter / ward does not put in a minimum of 75 percent attendance
in each course during the semester, my son/daughter/ward will not be eligible to write the semester
examinations in that course and will have to repeat the course as and when offered next.
5. That I am aware that the curriculum for the various courses is liable to be revised or modified and that my
son/daughter/ ward will follow the syllabi for the various courses in force at the time of his her admission
and that any revision or modification made in the syllabi during the course of his / her study in the
institution will be binding on him / her.
6. That in case of my son's / daughter's / ward's progress in studies is uniformly poor in the institution his/
her studies are liable to be terminated by the issue of Transfer Certificate.
7. That in case my son / daughter / ward becomes a scholarship holder or comes to enjoy educational
concessions like half fee or full fee etc., and does not show special progress, the scholarships or
educational concessions are liable to be cancelled and that if my son's / daughter's/ ward's conduct and
character are not good these will be cancelled summarily.
8. That my son / daughter / ward is aware that breach of discipline and rules or bad conduct in extra
curricular activities will also entail summarily forfeiture of seat in the institution, in addition to such other
proceedings that may be taken against him / her.
9. That I am aware that if my son / daughter / ward is admitted into the hostel he / she will strictly abide by
the rules and regulations in force in the hostel and that any breach of discipline or rules or any unruly
conduct or undesirable activities will be summarily dealt with by the forfeiture of seat both in the hostel and
the institution in addition to such other proceedings that may be taken against him / her.
10. That I and my son / daughter / ward are aware that the Sri Eshwar College of Engineering is an
Autonomous College framing its own courses, curricula and assessment systems. We agree that my son /
daughter / ward will be bound by and abide by such rules and regulations relating to curricula,
examination assessment and other academic matters as may be framed from time under the autonomous
functioning of the Sri Eshwar College of Engineering.
11. That we shall not seek for transfer to any other Engineering College during, the 3years/4 years tenure of
study of my son / daughter / ward under any circumstances.

(Signature of the Candidate) (Signature of the Parent)

Name of the Candidate (With Name and Address)

(in BLOCK LETTERS)
 PHYSICAL FITNESS CERTIFICATE

I do hereby certify that I have examined

Thiru / Selvi a candidate for admission
to the Programme
and confirm that he / she does not has any disease and constitutional defect or bodily
infirmity except (*) .

(*) I do not consider this as a disqualification for undergoing the courses in Engineering.

His / Her age according to his / her own statement is year

and by appearance about _ years. He/She has marks of small
pox /
vaccination.

Personal marks of identification

1.
2.

Blood Group & Rh Type :

General Examination: Height cms; Weight kgs.

Pulse / Min; B.P_ mm Hg
Resp. Rate / Min; Insp cms; Exp
cms

Date : Signature of Medical Officer with Seal

Place :

(*) Any defect or other disabilities when present should be noted in detail.
 FIRST GRADUATE CONCESSION -JOINT DECLARATION FORM

I hereby declare the following details of my family members and their education
qualifications to avail the tuition fee waiver for my studies in professional courses under the
scheme of waiver of tuition fees to the students from the family where there are no graduates.

Sl. Name Relationship Father / Age Educational Whether

No Mother / Brother / Qualification Degree
Sister / Grand Father holder
/ Grand Mother
(1) (2) (3) (4) (5) (6)

Applicant

Father

Mother

Father’s Father

Father’s Mother

Mother’s Father

Mother’s Mother

Brother / Sister

Brother / Sister

I hereby solemnly and sincerely affirm that I am the first person from my family to claim
the waiver of Tuition Fee for entire Professional Course of study and there is no graduate in my
family so far. The particulars furnished above are true. Should it, however, be found that any
information furnished therein is false in material particulars on verification at a large stage, I am
liable for criminal prosecution and I also agree to return the amount equal to three times the
tuition fee waiver availed by me.

Date :

Place : SIGNATURE OF THE CANDIDATE

I solemnly and sincerely affirm that I am fully aware of the above declaration and the
particulars furnished in the declaration are correct. I am liable for the criminal action / recovery
of amount equal to three times of the fees waived, for incorrect particulars furnished.

Date :

Place : SIGNATURE OF THE PARENT / GUARDIAN