National Institute of Technology Patna(An lnstitution of National lmportance under MHRD, Govt. of lndia)

Ashok Rajpath, Patna - 800 005 (Bihar)Website address - www.nitp,ac,rn

Prof. S.K.VermaProfessor in Mech, Engg, Deptt. &

Dean (Academic)

Mob 09430249743

Phone: 237171 5.23727 l5 (Ext. l5 I )

Fax:0612-2670631Email: dean.ac@nitp.ac.in

Letter No. I l6 lAcad.ll9-20 Date:20.06.2019NOTICE

This is to infom that the candidate who has been allotted the seat at National Institute of Technology Patna

(NlT Patna) for M.Tech/MURP/M.Arch Programme for Session 2019-20 through CCMT 2019 respectively

are advised to repoft at this Institute as per the following schedule. The candidates are required to download

the format of I) Affidavit for Gap Year (as per xi), 2) Affidavit for anti-ragging by Student and

Parent/Guardian (as per xii & xiii) and 3) Medical Examination Report as per xiv) frorn the Institute's website

and sr"rbmit the completed forms at the tirne of admission. These documents may be completed from

candidate's residing place or from Patna.

Particulars M.Tech/MURP/M.ArchProgramme

Admission Fee Session 2019-20 (Odd Sernester) 70,4501-Reporting Date at N IT Patna lor Adrnission who have been allotted seat in I

2r*l g . 'nr Round through CCM I--20 l924.06.2019 to 27.06.2019

Repofting Date at NIT Patna for Adrnission who have been allotted seat inNational Spot Round (NSR through CCMT- 2019)

23.07.2019 to 26.07.2019

Starl of Class 29" July 20l9Documents required to be submitted by the candidate: (Self attested photocopies of the following).ORIGINAL of all certificates & marks sheet must be produced for verification at the time ofadmission.

Reporting letter / Provisional Admission Letter of CCMT - 2019GATE Score Card

i) Cerlificate of Category, OBC /SC/ST/EWS if applicablev) Certificate for Person with Disabilities if applicable

Class X (Hieh School/Board certificate as proof of date of birth)Marks Sheet of Matric ( 10"' ), lntermediate /+2

vii) Oual fvins Exam nation Marks Sheet / Grade Card for B.Tech/B.Archviii) Oual fyins Exarn nation passins certificate (As applicable for the prograrnme)

ix) Four copies ofrecent passport size Photographs

x) Misration ceftificate (Orieinal)

xi) Affidavit with respect to Gap Year (i.e. reason for discontinuity between passing year of qualifyingexamination and year of adrnission)

xii) Affidavit for anti-ragging by the Student in the fonnat prescribed by the NIT Patna (To be issued frornthe CourtNotary )

xiii) Affidavit for anti-ragging by the Parent/Guardian in the format prescribed by the NIT Patna (To be

issued from the Courttrlotary )xiv) Medical Exarnination Reporl in the forrr-rat prescribed by the NIT Patna ( To be obtained frotn a

Registered Medical Practitioner)xv) Undertaking on non-judicial stamp paper of Rs. 100/- regarding refund of atnount received as

scholarship/stipend in case of withdrawal /leaving the institute before cornpletion of the course as per

enclosed fonnat.

_ 16-t2_

Note:l. Hostel facility is presently not available at NIT Patna for the student adrnitted in

M.Tech/MU RP/M.Arch programme.2. Admission process wilI not be cornpleted till the payment of balance amount i.e Rs. 40450/- (Forty

Thousand Four Hundred Fifty Only) after adjustrnent of seat acceptance fee deposited at the tirne ofcounseling. The fee is payable through Net Banking/Debit Card/Credit Card.

Copy to:l. All HODs., PI(PG), Chairman (HMC)2. Sec. to Director, PA to Registrar3. PI (Website) with a request to upload on website of the Institute.

,re%?s\1d;mlturu,t t ,

llational lmtituu ol Tschnology Pstna';ffik RaJ Path, Patna-8ooo05

BTNIN INDIA

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To

The Notary Public

--------------------------

A f f i d a v i t f o r G a p Y e a r

I _______________________________________________________________

S/O _____________________________________________________________

Resident of ____________________________ P.O. ______________________

P.S. ____________________________District __________________________

do hereby solemnly declare and affirm as follows:-

1. That I have passed the qualifying examination ______ ______ ____ _____

from _____ _____ _____ ______ ______ ______ _____ _____ in the year

_____ ______

2. That after passing the aforesaid examination I have not taken admission in

any college/ school/ institution during the period from _______________

___________________ till this date.

3. That after passing of the qualifying examination, I was not involved in any

criminal offence during the period from ______ _____ _____ till this date.

4. That from _____________________ the date of reporting/ admission to

___________________ the date of reporting for attending classes, I was sick

and was under treatment of Dr. ____________________ ________________

That the contents of this affidavit are true and correct to the best of my

knowledge and belief.1

Signature of the candidate/ Deponent

I identify the deponent who signed in my presence.

1 Delete/ Strike out if not applicable

1 of 2

AFFIDAVIT BY THE STUDENT

I, _____________ ___________________________ _________________ (full name of student with

admission/ registration/ enrolment number) s/o d/o Mr./Mrs./Ms. _______ ____ ________ _______________ _________________ , having been admitted to National Institute of Technology Patna (name of the

institution) , 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 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 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

2 of 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 number) , having been admitted to National Institute of

Technology Patna (name of the institution) , 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 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

NATIONAL INSTITUTE OF TECHNOLOGY PATNA

(An Institute under Ministry of HRD, Govt. of India)

ASHOK RAJPATH, PATNA-800 005 (BIHAR)

…………………………………………………………………………………….………………………………………………………………………………

MEDICAL EXAMINATION FOR PHYSICAL FITNESS

(To be obtained from any Registered Medical Practitioner)

Name: ………............................................................. S/O........................................................................................

I. General Examination: …………….. ……… Height …………cms. Weight ………....Kgs.

II. C.V.S. : Pulse: ……………/ Minute; Regular / Irregular B.P.: …………………………..

III. Respiratory System: ……………………………………………………………………………………..

IV. GI System: ………………………………………………………………………………………………

V. Musculoskeletal System : Normal / Disabled (If disabled refer to a specialist)

VI. Skin: ………………………………………………………………………………………………….….

VII. Examination of Eyes: Normal / Defective: ……………………… Spectacles………………………….

(If any abnormality is found, refer to the specialist)

VIII. E.N.T.: Normal / Abnormal: …………………………………..

(If any abnormality is found, refer to the specialist)

IX. C.N.S.: ………………………………………………………………………….……………………….

X. G.U.S.: …………………………………………………………………………………………………..

XI. Female Candidate: Menstrual History: ………………………………………………………………….

XII. Blood Group & Rh: ……………………………………………………………………………………..

I do hereby certify that I have examined the above candidate for admission to ……………………….. Programme

in National Institute of Technology Patna, ………………………… department and cannot discover that he / she

has any disease and constitutional defect or bodily infirmity except that

……………………………………………… I do not consider this as a disqualification for undergoing the above

programme. His / Her age according to his/her own statement is ………………………. years and by appearance

……………. years.

Personal Marks of Identification:

1…………………………………………………………….……..

2……………………………………………………………………

Date:

Place: Signature of Doctor

(With seal & Regd.No.)

(* Any defect to be noted in Detail)_____________________________________________________________

__________________________________________________________________________________________

NATIONAL INSTITUTE OF TECHNOLOGY PATNA

(An Institute under Ministry of HRD, Govt. of India, New Delhi) ASHOK RAJPATH, PATNA-800 005 (BIHAR)

………………………………………………………………………………………………………………………………………………………........................

CERTIFICATE OF PHYSICAL FITNESS (Declaration by the candidate for the issue of Physical Fitness Certificate)

Name: …………………………………………………………… Male/Female Branch: …………………………

Date of Birth: Age (in years):

Address: ………………………………………………………………………………………………………………

………………………………………………………………………………………………………………..

Indicate your response by Y/N (Y means Yes; N means No)

Do you have any minor or major complaint?

If yes, describe …………………………………………………………………………

Are you allergic to any medicine or any others?

If yes, describe …………………………………………………………………………

Have you ever been affected with?

Small Pox, Chicken Pox Asthma

Intermittent or any fever Epilepsy

Enlargement or suppuration of glands Appendicitis

Spitting of Blood Lungs Disease

Heart Disease Rheumatism

Fainting Attacks Any Other ……………………

Have you ever had any operation or been advised any operation?

If yes, describe …………………………………………………………………………………………..

Are you handicapped? Visual / Hearing / Orthopedic

Immunization had: BCG OPV DPT M.M.R. ……………

Preventive vaccination (Please tick):

Chicken Pox Typhoid Hepatitis-B

Rubella (F) Any other (specify)…………………………

Blood Group & Rh ………………………………………………………………………………………………….

Personal Marks of Identification: 1...……………………………………………………………………………….

2. …………………………………………………………………………………

I declare that all the above information are true and to the best of my knowledge.

Signature of the Candidate

UNDERTAKING (On non-judicial Stamp Paper of Rs. 100/-)

I _________________ son/daughter of ________________________ resident

of ____________________ hereby declare that I will refund the amount

received by me from the Institute as scholarship / stipend, in case I withdraw

from / leave the Institute before completing the requisite criteria for Award of

of my M.Tech/MURP/M.Arch. Degree as per the academic Regulation of the

institute.

Signature of the Candidate Signature of the Guardian