APPLICATION FORM FOR ADMISSION TO M.TECH./M.PHARM. PROGRAMME CHECKLIST (Tick the Enclosed Documents. Please enclose only attested COPIES. Please refer to the ADMISSION PROCEDURE for bringing along the ORIGINALS for verification. Wherever applicable, mention the CERTIFICATE NO. as prescribed in ADMISSION PROCEDURE)
Sl No Tick Particulars 1* Print out of On-Line Application Form (with photograph) 2* Demand Draft of Rs 1000=00 (or Rs 500=00) in favour of The Finance Officer, Gautam Buddh Technical University, Lucknow payable at Lucknow. 3* Date of Birth Certificate or the High School (class X) Certificate with Date of Birth. 4* SC/ST/OBC/DOMICILE etc certificates (all those are applicable). 5* Copies of degrees, marks/grade sheets of all the examinations passed. 6* Medical Certificate 7 Copy of GATE SCORE (if applicable) 8 No Objection Certificate from the employer (for employed applicants). 9 Copies of publications (if applicable). Total No. of Enclosures : . No. of Sheets : 1. : Required
Signature
Name
GAUTAM BUDDH TECHNICAL UNIVERSITY, LUCKNOW (Formerly Uttar Pradesh Technical University, Lucknow) M. TECH. and M. PHARM. PROGRAMME ADMISSION PROCEDURE 1. ADMISSIONS
1.1 Gautam Buddh Technical University, Lucknow (Formerly Uttar Pradesh Technical University (UPTU), Lucknow) coordinates and awards post graduate masters degree leading to Master of Technology (M. Tech.) and Master of Pharmacy (M. Pharm.) Degrees in certain fields of specialization. The programmes are conducted at various institutions approved by University from time to time. 1.2 The process of admissions to the M. Tech. and M. Pharm. Programme is centrally coordinated by the University for all the fields of specialization and for all the institutions listed in section 2. 1.3 Reservation in admission shall be governed by the U.P. State Govt. rules. In case of non-availability of suitable candidates in any category, the decision of University for filling up vacant seats shall be final.
2. COURSES OFFERED
2.1 M. Tech. Programme/ Institutions/ Intake (i) Govt. / Govt. Aided Institutions Institute Code Name of the Institution Stream of Engineering/ Technology Specialization of M. Tech. Programme Intake 042 M.M.M. Engineering College, Gorakhpur Civil 1. Environmental Engineering 18 Civil 2. Hill Area Development Engineering 18 Civil 3. Seismic Design & Earthquake Engineering 18 Civil 4. Structural Engineering 18 Electrical 5. Power Electronics and Drives 18 Electronics 6. Digital Systems 18 7. Communication Engineering 18 Mechanical 8. Computer Integrated Manufacturing 18 Computer Science 9. Computer Science and Engineering 18 10. Information Technology 18
043 Bundelkhand Institute of Engineering & Technology, Jhansi. Electronics 1. Digital Communications 20 Civil 2. Construction Technology & Management 18 Mechanical 3. Manufacturing Science & Technology 18 Civil 4. Environmental Engineering 18 Mechanical 5. Thermal Engineering 18 044 Uttar Pradesh Textile Technology Institute, Kanpur. Textile 1. Textile Technology 12 Textile 2. Textile Chemistry 18 045 Harcourt Butler Technological Institute, Kanpur Chemical 1. Chemical Technology with specialization in Bio-Chemical Engineering/ Food Technology/ Oil Technology 34 2. Chemical Engineering 18 Mechanical 3. Computer Aided Design 18 Electronics 4. Electronics & Communication Engineering 18 Civil 5. Environmental Science & Engineering 18 052 Institute of Engineering & Technology, Lucknow. Civil 1. Environmental Engineering 18 Bio-Technology 2. Bio-Technology 18 Electronics 3. Micro-Electronics 15 104 Kamla Nehru Institute of Technology, Sultanpur. Electrical 1. Power Electronics & Drives 18 Mechanical 2. Thermal Engineering 18 Civil 3. Geotechnical & Environmental Engineering 18 Computer Science 4. Computer Science & Engineering 18 Electronics 5. Communication Engineering 18 190 DOEACC Centre, Gorakhpur Electronics 1. Electronics Design and Technology 18
(ii) Private Institutions Institute Code Name of the Institution Stream of Engineering Specialization of M. Tech. Programme Intake 010 United College of Engineering and Research, Allahabad Computer Science 1. Computer Science & Engineering 18 Mechanical 2. CAD (2 nd Shift) 24 Electronics 3. Power Electronics (2 nd Shift) 24 014 Sri Rammurty Smarak College of Engineering & Technology, Bareilly Mechanical 1. CAD-CAM 15 Computer Science 2. Software Engineering 15 Electronics 3. Microwave Engineering 18 Electrical 4. Electrical Drive & Control 18 046 Maharana Pratap Engineering College, Lucknow Electronics 1. Electronics & Communication Engineering 18 Mechanical 2. Mechanical Engineering 18
053 Azad Institute of Engineering & Technology, Lucknow Electronics 1. Instrumentation & Control Engg 18 Mechanical 2. Advance Computer Aided Design 18 Computer Sc. 3. Distributed System (Second Shift) 18 Information Technology 4. Infrastructure Management (2 nd Shift) 18 Mechanical 5. Industrial & Production Engg,( 2 nd Shift) 18 054 B.B.D. National Institute of Technology & Management, Lucknow Mechanical 1. Production Engineering 18 056 Babu Banarasi Das Northern India Institute of Technology, Lucknow Electronics 1. Digital Communications 18 123 Saroj Institute of Technology & Management, Lucknow Computer Science 1. Computer Science & Engineering 18 Electronics 2. Electronics & Communication Engineering 18 Electrical 3. Power Electronics 18 Mechanical 4. Thermal Engineering 18 Computer 5. Information Technology 18 138 B.B.S. College of Engineering & Technology, Allahabad Mechanical 1. Advanced CAD 18 141 Sagar Institute of Technology & Management, Barabanki Mechanical 1. Mechanical Engineering 18 145 College of Science & Engineering, Jhansi Computer Science 1. Computer Science & Engineering 18 Electronics 2. Electronics & Communication Engineering 18 Civil Engineering 3. Civil Engineering 18 Mechanical 4. Mechanical Engineering 18 162 Shambhunath Institute of Engineering & Technology, Allahabad Electronics 1. VLSI Design 24 Mechanical 2. Production Engineering 24 164 Pranveer Singh Institute of Technology, Kanpur Electronics 1. Electronics & Communication Engg. 18 Mechanical 2. CAD 18 Computer 3. Computer Science & Engineering 18 165 Kanpur Institute of Technology, Kanpur Computer Science 1. Computer Science & Engineering 18 Electronics 2. Electronics & Communication Engineering 18 Mechanical 3. Mechanical Engineering 18 254 Bhabha Institute of Technology, Kanpur Dehat Mechanical 1. Mechanical Engineering 18 Electronics 2. Electronics & Communication Engg. 18 284 United Institute of Technology, Allahabad Electronics 1. Electronics & Communication Engg. (2 nd
Shift) 24 Computer Sc. 2. Computer Science & Engg. (2 nd Shift) 24 360 Goel Institute of Technology & Management, Lucknow Computer Sc. 1. Computer Science & Engineering 18 Electronics 2. Electronics & Communication 18 361 R.R. Institute of Modern Technology, Lucknow Mechanical 1. Mechanical Engineering (2 nd Shift) 24 2. Electronics Engg. (2 nd Shift) 24
M. Pharm. Programmes / Institutions / Intake Private Institutions
Institute Code Name of the Institution Specialization of M. Pharm. Programme Intake 012 Pharmacy College, Azamgarh 1. Pharmacology 18 2. Pharmaceutics 18 3. Pharmaceutical Chemistry 18 014 Sri Rammurty Smarak College of Engineering & Technology, Bareilly 1. Pharmaceutics 18 041 Archarya Narendra Dev College of Pharmacy, Gonda 1. Pharmaceutical Chemistry 10 056 B.B.D. Northern India Institute of Technology, Lucknow 1. Pharmaceutical Chemistry 18 2. Pharmacology 18 3. Pharmaceutics 18 123 Saroj Institute of Technology & Management, Lucknow 1. Pharmaceutical Chemistry 18 2. Pharmacognosy 18 3. Pharmaceutics 18 144 Prasad Institute of Technology, Jaunpur 1. Pharmaceutics 18 2. Pharmacology 18 164 Pranveer Singh Institute of Technology, Kanpur 1. Pharmaceutical Chemistry 18 2. Pharmaceutics 18 3. Pharmacology 18 167 Rajarshi Rananjay Sinh College of Pharmacy, Sultanpur 1. Pharmaceutics 18 2. Pharmacology 18 168 Smt. Vidyawati College of Pharmacy, Jhansi 1. Pharmacology 18 2. Pharmacognosy 18 169 Rakshpal Bahadur College of Pharmacy, Sultanpur 1. Pharmaceutics 18 2. Phramaceutical Chemistry 18 186 Kamla Nehru Institute of Management & Technology, Sultanpur 1. Pharmaceutical Chemistry 10 2. Pharmaceutics 18 3. Pharmacognosy 18 188 Advance Institute of Biotech & Paramedical Sciences, Kanpur 1. Pharmaceutics 18 2. Pharmaceutical Chemistry 18 3. Pharmacology 18 4. Pharmacognosy 18
197 Azad Institute of Pharmacy & Research, Lucknow 1. Pharmaceutics 30 2. Pharmaceutical Chemistry 18 3. Pharmacology 18 202 Hygia Institute of Pharmaceutical Education and Research, Lucknow 1. Pharmacology 18 2. Pharmaceutics 18 3. Pharmaceutical Chemistry 18 203 Rameshwaram Institute of Technology & Management, Lucknow 1. Pharmacology 18 2. Pharmaceutics 18 3. Pharmacognosy 18 4. Pharma Chemistry 18 233 R.K.College of Pharmacy,Azamgarh 1. Pharmacology 18 236 Sir Madan Lal Institute of Pharmacy, Etwah 1. Pharmaceutics 18 2. Pharmacology 18 3. Pharmacognosy 18 246 Dayanand Dinanath College, Institute of Pharmacy, Kanpur 1. Pharmaceutics 18 260 IBNE SEENA Pharmacy College, Hardoi 1. Pharmaceutics 18 262 Institute of Pharmaceutical Science and Research, Unnao 1. Pharmaceutics 18 315 United Institute of Pharmacy, UCER Allahabad 1. Pharmacology 18 2. Pharmaceutics 18 316 Aryakul College of Pharmacy & Research, Lucknow 1. Pharmacology 18 2. Pharmaceutics 18 3. Pharma Chemistry 18 391 Mahatma Gandhi Institute of Pharmacy, Lucknow 1.Pharmacology 18 2. Pharmaceutics 18 392 Goel Institute of Pharmacy & Sciences, Lucknow 1. Pharmaceutics 18 2. Pharma Chemistry 18
3. ELIGIBILITY CRITERIA:
3.1. The applicant for M. Tech./ M. Pharm. programmes must fulfill the following criteria:
i. General/ OBC candidates, with 60 % marks in graduation in Engineering or Technology/ B. Pharm. or equivalent, are eligible.
ii. SC/ST candidates, with 55 % marks in graduation in Engineering or Technology / B.Pharm. or equivalent, are eligible.
iii. For admission to M.Tech. (Computer Science, Information Technology and related branches), candidates having degree of MCA, M.Sc.(Computer Science) or M.Sc. (Information Technology) with at least 60% marks for General/OBC candidates and 55% marks for SC/ST candidates are also eligible.
iv. For admission to M.Tech. (Electronics Engineering and related branches), candidates having degree of M.Sc. (Electronics) with at least 60% marks (for General/OBC candidates), and 55% marks (for SC/ST candidates) are also eligible.
v. For admission to M.Tech. (Chemical Technology and related branches), candidates having degree of M.Sc. (Chemistry) with at least 60% marks (for General/OBC candidates), and 55% marks (for SC/ST candidates) are also eligible.
vi. For admission to M.Tech. (Hill Area Development Engineering)/ M.Tech. (Environmental Engineering), B.Tech. /B.E. or equivalent in any branch of engineering/technology OR B.Arch. or equivalent. OR M.Sc. in any discipline or Masters degree in Mathematics / Geography with at least 60% marks (for General/OBC candidates), and55% marks (for SC/ST candidates) are also eligible.
Candidates not having Mathematics at Intermediate level shall be required to compulsorily qualify a non-credit course on Mathematics of Intermediate level in the first semester of M.Tech. programme.
vii. For admission to M.Tech.(Bio-Technology), candidates having degree of M.Sc. in Physical/ Chemical/ Biological/ Veterinary/ Agricultural Science or Biotechnology or Bioinformatics or equivalent degree in relevant disciplines or B.E./B.Tech. in Chemical /Bioinformatics /Biochemical /Food/Agriculture/ Environmental or equivalent degree in relevant discipline or MBBS/ B.Pharm./ B.V.Sc./B.D.S with at least 60% marks (for General / OBC candidates), and 55% marks (for SC/ST candidates) are also eligible.
viii. For admission to M.Tech. (Plastic Engineering), candidates having degree of B.Tech./ B.E. in Chemical Engineering/ Chemical Technology / Polymer Science & Technology / Mechanical Engineering / Production Engineering/ Petrochemical Technology or equivalent of above degrees / course or M.Sc. Chemistry / Industrial Chemistry / Polymer Science with at least 60% marks (for General / OBC candidates), and 55% marks (for SC/ST candidates) are also eligible.
ix. For admission to M.Tech. (CAD-CAM), candidates must have B.Tech./ B.E. in Mechanical Engineering/Automobile Engineering / Chemical Engineering/ Chemical Technology / Civil Engineering or allied branches with at least 60% marks (for General / OBC candidates), and 55% marks (for SC/ST candidates).
x. For admission to M.Tech. (Automation & Robotics), candidates must have B.Tech. / B.E. in Mechanical Engineering/Electrical Engineering/ Electronics & Communication Engineering / Computer Science & Engineering or allied branches with at least 60% marks (for General / OBC candidates), and 55% marks (for SC/ST candidates).
3.2 The equivalency of any degree for admission to any programme will be decided by the University. The eligibility criteria given above are minimum and mere possessing the same does not qualify the eligibility for admissions. University may prescribe any other requirements over and above these conditions.
4. SELECTION PROCEDURE
4.1 The candidate has to fill an application form on-line with all the relevant details and send print copy of the same along with requisite fee and certified copy of documents related to qualifications on or before the last date prescribed by the University. The on-line application is available on website www.uptu.ac.in. The candidates should fill in and sign the check list and submit along with the form. 4.2 The sort-listed eligible candidates shall be called for counselling. The schedule of counselling will be available on the University website www.uptu.ac.in. 4.3 The number of seats, programmes & institutions may change under very special circumstances. The same will be posted on the website of the university. 4.4 Students having domicile of Uttar Pradesh shall be given first preference and subsequently the candidate having domicile outside U.P. will be considered only if seats are vacant/ unfilled. 4.5 Candidates with qualifications stated in Section 3 and with valid GATE/GPAT scores will be given first preference in admission. 4.6 Graduates in Engineering / Technology without valid GATE/GPAT scores will be given second preference in admission. 4.7 However, the candidates with eligibility criteria as stated in section 3, and B.Tech. / B.Pharma at graduation level shall be preferred over MCA/ M.Sc. candidates at the time of counseling.
5. RESERVATIONS: Reservation shall be applicable as per the State Govt. norms as prescribed by the Technical Education Department. 6. MEDICAL STANDARDS 6.1 Candidates called for counseling will have to submit an undertaking for Medical fitness on Certificate Number- 5. 6.2 The candidate should have to submit Medical certificate on proforma given as Certificate Number - 4 at the time of admission in the college allotted. Physically Handicapped / Disabled: Type I Minimum 40% permanent Visual impairment Type II Minimum 40% permanent Locomotors disability Type III Minimum 40% permanent speech and Hearing impairment
7. COUNSELING 7.1 Counseling shall be held at G.B. Technical University (formerly U.P. Technical University, Lucknow), IET Campus, Sitapur Road, Lucknow. The information about counseling schedule, procedures and list of sort listed candidates will be available on website: www.uptu.ac.in. only after 26 th August, 2012. NO separate counseling letter shall be sent. The candidates are advised to visit website frequently for counseling details. 7.2 The candidates called for counseling will be required to come with original certificates of qualifying examination, mark sheet, weightage certificate, domicile and category/reservation certificates etc. with one attested copy of each. In case the candidates do not submit the proper category/ reservation certificate in the prescribed proforma at the time of counseling, the advantage of reserved category shall not be provided and they will be treated in General Category. If a candidate has passed qualifying examination from outside of U.P., he/she has to bring the domicile certificate of his/her parents (Father or Mother) only at the time of counseling. The candidate must note that his/her domicile certificate is not acceptable, in place of his parents certificate and no request shall be entertained for relaxation. 7.3 Verification of original documents shall be carried out at the time of counseling. The candidates will not be considered for admission if he/she does not submit the original documents at the time of counseling. However the originals will be returned to candidate after verification. 7.4 The initial fee of Rs. 5,000/- will be deposited at counselling centre in the form of Bank draft. This fee is adjustable against total fee payable at Institution if candidate takes admission at allotted institute. The initial fee of Rs. 5,000/- will be forfeited if the candidate does not take admission in the allotted institution. Requests for return of this fee in such case will not be entertained. 7.5 In addition to initial fee the candidate called for counselling has to deposit a separate bank draft of Rs. 500/- as counselling fee. This counselling fee is non- refundable. 7.6 All the Bank drafts must be prepared separately and drawn in favour of Finance Officer, G. B. Technical University, Lucknow payable at Lucknow.
8 DOCUMENTS REQUIRED AT THE TIME OF COUNSELLING The candidates are required to bring the following documents, in original along with one set of photocopies with them at the time of Counseling: (a) High School Certificate. (b) Mark sheets of qualifying examination. (c) Valid GATE Score Card (d) Category and Subcategory certificate(s), if applicable. (e) Passport size Photos. (2 Nos.) (f) Domicile Certificate (g) Medical Certificate / Undertaking
9 DOMICILE REQUIREMENTS 9.1 Candidates, who have passed the qualifying examination from an institution located in the State of Uttar Pradesh and who do not claim for any reserved category are eligible for admission to all the courses at all the institutions against available General (OPEN) seats (No certificate required). [Code: UPGE] 9.2 Candidates, who have passed the qualifying examination from an institution located in State of U.P.; and are domicile of U.P.; and belong to Schedule Caste (SC) of U.P. / Schedule Tribe (ST) of U.P. / Other Backward Classes of U.P. are eligible for admission against available reserved seats of their category. Certificate no. 1 or 2 as applicable is required. [Respective Codes: UPSC / UPST / UPBC]
9.3 Candidates, who have passed the qualifying examination from an institution located outside U.P.; and whose parents are domicile of U.P.; and who have not claimed for any reserved category, are also eligible for admission to courses offered at all institutions under General (OPEN) category. Such candidate has to produce the domicile certificate of his/her parents (Father or Mother only) at the time of counseling (certificate no. 3). [Code: UPGD] 9.4 Candidates, who have passed the qualifying examination from an institution located outside U.P.; and whose parents are domicile of U.P.; and who belong to Schedule Caste of U.P. / Schedule Tribe of U.P. / Other Backward classes of U.P. are also eligible for admission against reserved seats of their category. Such candidate has to produce the domicile certificate of his/her parents (Father or Mother only) (certificate no. 3) and category certificate (no. 1 or 2 as applicable) at the time of counseling. [Respective Codes: GDSC/GDST/GDBC]
Proforma of various certificates are available in Appendix A
10. OTHER INFORMATIONS
1. Incomplete applications will be rejected. 2. No TA / DA will be admissible to the candidates called for counseling. 3. The decision of the University for the selection of candidates shall be final.
11. INSTRUCTIONS FOR FILLING ON-LINE APPLICATION FORM Select any of the courses (M. Tech. or M. Pharm.) from the Course Dropdown. After selecting the course, the related specialization options would appear in the Specialization section. Select Specialization as per your choice by clicking on them and you can select multiple specialization by pressing control button on the keyboard and selecting the specialization or you can select it one by one also. After making the selections click the Right Arrow button on the screen to move them in the selection list pane. If you want to remove some of the specializations from the selection pane, select by clicking on it and click the Left Arrow button on the screen to move them back into the Select Specialization field. After making the complete selection, click on the Submit button to navigate to the Form page for filling the application. Click Reset button to clear all the selected fields on this page, in-case of any mistake. On the Form page, fill in the Draft number, Name of the draft issuing bank, Date of Issue ( DD/MM/YYYY format) and Amount from the dropdown (Rs. 500 or Rs. 1000) Then fill in all the particulars of the candidate viz. Name, Date of Birth, Fathers name, Address, Telephone, Mobile, Fax and Email along with the Category, Gender, Domicile and Nationality (Indian or Others). Further, fill in the Particulars of Qualifications which is Examinations passed, Subject/Branch, Name of University/Institution, Year of Passing, Division and Percentage of Marks. Fill in the till-date aggregate total in case for the candidates who have appeared for the final examination and are waiting for their final result. Fill in your GATE score details, if available. Fill in the field Place, Upload your Photograph by clicking the Browse button and selecting your scanned Photograph saved on the hard-drive of your system. MAKE SURE THAT THE PHOTOGRAPH IS IN JPEG FORMAT AND IT SHOULD NOT BE MORE THAN 100 MB. Click and check the Checkbox for the declaration from the student that at all the information furnished is correct then click Submit button to submit the filled form. Click Reset button to clear all the filled fields on this page, in-case of any mistakes or if you want to fill the un-submitted Form again. Click here to download the CHECKLIST which you would be required to send along with the printout of this form.
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CERTIFICATE 2 (sii sz)
a-a s<zi + -4 fs n + fny ifa sii s +i ss (UPBC/GDBC)
t nili- l+i i-i t l+ iin-i +nii ................................................................. =z=zi i .....................................................................................l-i=i nin ....... ............................................. -t=in ........................................ -n ........................ .... lni ............................................. -- <zi i +i ...................................... lzi il- + l+- t t il- -- <zi ni+ =i ~-=l-- il-i ~-=l-- -il-i -ii lz ni + ln( ~i-ii ~lil-n. +- +i ~-=-i + + ~--n- ni--i i-- t t ii nili- l+i i-i t l+ iin-i+nii .............................................................. ................ -+- ~lil-n +- +i ~-=-i . (~li=--i =i ..+-.+i c.+: ic =ic l<-i+ l<=-. +: ,ii ii =ziili-) = ~i-zil<- -ti t iin-i+nii ................................................................ -ii ~ii --+i li -- <zi + nin ..................... iin-i+nii ....................................... -n .................. .......................... lni ................................... n =ini--i t-i t
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CERTIFICATE - 3 (izek.k i=&3)* a-a s<zi n faiut + s / st (UPGD/GDSC/GDST/GDBC) {au fn + fri+it zii sifia fu fn + iai/fsai faiut r)
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l<-i+ t--i-i lni nl- -ii- i -in <-in nt (lni nl- +i =in)
*fni faa ii fni faa zii fria s fni faa/u fta faa zii sii si rt i-4 rin i ziioio uoisz/ata zoozz{II)/s f<ai+ is +t, zoo + rita it f+4i i4ni+
aianii z. ~ii + ni-il-i +i -i ti-i -ilt( +il+ ~ii l-ti- ~t+ii i-ii -- <zi + it l-i- l+=i lin = --ii +i t -- --+ ni-il-i -- <zi + nn-ii: l-i=i t
CERTIFICATE 4 (sii s4) * FORMAT FOR MEDICAL CERTIFICATE (To be obtained from a Chief Medical Officer or Medical Officer of a participating U.P. State Funded Engineering Institute)
This certificate has to be submitted at the time of admission in the college allotted.
( To be filled in by the Candidate ) Name of Candidate: Age: Sex: Category: Subcategory : Father's Name:
L.T. M.I. Height Weight Chest Abdomen V I S I O N Colour Vision: Without glass: With glass: History Operation Kockh's Colics B.P.
Seizures Asthma Piles Diabetes E X A M I N A T I O N Pulse Tonsil DNS Hernia
Pallor L.Nodes CSOM Hydrocele Cardiovascular CNS
Respiratory GIT
Genitourinary Others Is the candidate physically handicapped/Disabled: (Please tick) Yes / No If yes, type of handicap/disability: Type-I: Minimum 40% permanent Visual impairment (Please trick P the type of handicap/disability) Type-II: Minimum 40% permanent Locomotors disability Type-III: Minimum 40% permanent speech and Hearing impairment Any other finding: Certified that the candidate is physically fit/unfit/temporally disqualified to pursue engineering studies
Signature of Candidate Signature of the issuing Medical Officer ( with Official stamp)
CERTIFICATE 5 (sii ss) UNDERTAKING BY CANDIDATE FOR MEDICAL FITNESS
I certify that I have no such physical handicap/disability which would hinder the pursuit of studies in the courses in which I am seeking admission. If at stage it is found that I have a physical handicap/ disability which would hinder the pursuit of studies in the courses in which I am seeking admission then my admission will be liable to be cancelled. I will produce medical fitness certificate from a C.M.O./C.M.S. at the time of my joining the institution allotted by GBTU-counseling.
Date: Counter Signed by Father / Guardian Signature of the Candidate