Office of Hostel Management
IIT - Madras
Student Biodata Form
Student Details
Application No : CH21B103 Student Id : CH21B103
Student Name : SIDDHARTH CHAUHAN Date of Birth : 2003-10-12
Mobile Number : 8199982904 Category : General
Prefered Mess : North Indian Gender : M
Aadhar Number : 597375071067 PAN Number : COSPC3615K
Blood Group : B+ Other Info : GENERAL EWS
Faculty Name: Faculty No: 0
Address : House No D-39 Jindal Ind. LTD. Model
Town ,Hisar, Haryana
Family Details
Relation Type : Father Age : 43
Relation Name : Satbir Singh Chauhan Occupation : Pvt. Job
Mobile No : 8199982904
Email : [email protected]
Annual Income : 180000
Relation Type : Mother Age : 40
Relation Name : Meena Kumari Occupation : house wife
Mobile No : 9034613799
Email : [email protected]
Annual Income : 0
Page 1 of 3
Relation Type : Brother Age : 16
Relation Name : Vansh Occupation : student
Mobile No : 8199982904
Email : [email protected]
Annual Income : 0
Self Declaration By Students
I, SIDDHARTH CHAUHAN S/o D/o Shri./ Smt.SATBIR SINGH CHAUHAN having been admitted to
Indian Institute of Technology Madras, have:
• Read carefully and understood the Supreme Court Judgement on Ragging.
• Gone though the Essential Extracts of relevant Regulations on curbing the Menace of Ragging in
Higher Educational Institutions, 2009, (hereinafter called the relevant Regulations)
• Carefully read and fully understood the provisions contained there-in
I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what
constitutes ragging and the implications thereof.
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 in case I am found guilty of or
abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
I hereby solemnly state and undertake that:
• I will not indulge in any behaviour or act that may be considered as ragging under Clause 3 of the
relevant Regulations.
• 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
• 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 the
under any penal law or any law for the time being in force.
• 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.
Student Name Mobile Number Signature
SIDDHARTH 8199982904
CHAUHAN
Self Declaration By Parents/Guardians
Page 2 of 3
I, Mr./Mrs./Ms. SATBIR SINGH CHAUHAN Father / Mother / Guardian of Mr. / Ms. SIDDHARTH
CHAUHAN (CH21B103) who has been admitted to Indian Institute of Technology Madras have:
• I have read carefully and understood the Supreme Court Judgement on Ragging.
• I have gone though of the Essential Extracts of relevant Regulations on curbing the Menace of
Ragging in Higher Educational Institutions, 2009, (hereinafter called the relevant Regulations)
• Carefully read and fully understood the provisions contained there-in
I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what
constitutes ragging and the implications thereof.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 SIDDHARTH CHAUHAN (CH21B103) in case he/she is found
guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.I
hereby solemnly state and undertake that:
• My ward SIDDHARTH CHAUHAN (CH21B103) will not indulge in any behavior or act that may
be considered as ragging under Clause 3 of the relevant Regulations.
• My ward SIDDHARTH CHAUHAN (CH21B103) 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
I hereby affirm that, if found guilty of ragging, my ward SIDDHARTH CHAUHAN (CH21B103) 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 SIDDHARTH CHAUHAN (CH21B103) under any
penal law or any law for the time being in force.
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.
Parent Name Mobile Number Signature
SATBIR SINGH 8199982904
CHAUHAN
Power Vechicle Declaration
I, SIDDHARTH CHAUHAN S/o, SATBIR SINGH CHAUHAN hereby declare that I will not bring/use any
powered vehicle inside IIT Madras campus and I will abide by the rules and regulations of IIT Madras.
If I fail to abide, appropriate action(s) can be taken against me.
Date Candidate Signature Parent Signature
2021-11-24
