DOST - Dean of Students

Undertaking Reference No *

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Please visit https://www.antiragging.in/ to get the Reference No

Roll No *

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Student Name *

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Student Mobile No *

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Parent Name *

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Door No *

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House No *

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Street *

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Village/Town/City *

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State *

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Pin Code *

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Program *

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Department *

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Student Sign *

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Parent Sign *

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I hereby declare that :

a) 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 b) I have read and understood the prevailing rules and regulations of the Institute c) I am aware of

i. The national laws pertaining to ragging, ii. The serious consequences of this impermissible behavior (ragging), and iii. The administrative, legal and penal actions that will be imposed on persons apprehended, tried and convicted of this crime (ragging); and

d) I am aware of the ban on the possession and/or use of alcohol / tobacco / any other banned substances in any form as per Narcotic Drugs and Psychotropic Substances Act, 1985 and its amendmentsand e) I am aware of the ban on the use of any powered vehicles by students inside the IIT Madras Campus without permission and f) I authorize the Institute to inform my Parents/Guardian in case parental care is required for any medical/wellness issue.

Keeping the above in mind, I SOLEMNLY AFFIRM that:

a) I SHALL NOT violate the prevailing rules and regulations and any amendments thereof, of IIT Madras, my INSTITUTE; b) I SHALL NOT violate the prevailing rules and regulations and any amendments thereof, of Office of Hostel Management, IIT Madras; c) I SHALL NOT violate any rules and regulations framed during any Natural Disaster, Pandemic, National Emergency, Financial emergency or any other exigencies; d) I SHALL NOT do anything that prevents institute functionaries from carrying out their duties and functions or threatens them for carrying out their functions e) I SHALL NOT consume or possess any drugs and other banned substances in any form as per Narcotic Drugs and Psychotropic Substances Act, 1985 and its amendments f) I SHALL NOT involve in any activities that affect the wild life of IIT Madras campus and not bring any pets or stray animals within the hostel premises g) I SHALL NOT indulge in ragging, nor will encourage, abet, or be indifferent towards others engaging in ragging; and, on the contrary, will work to ensure the dignity, honor and self-esteem of all students; h) I SHALL NOT possess and/or use any alcohol / tobacco / any other banned substances in any form. i) I SHALL NOT USE any powered vehicle inside the IIT Madras campus, except with the due permission if applicable, and that

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SOLEMN AFFIRMATION OF CONFORMANCE TO RULES AND REGULATIONS

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