(Affidavit tobe notarized on Rs.10W- non judd ATION FOR CO 0 The Registrar © Symbiosis Intemational (Deemed University) Gram: Lavale, Tal: Mulshi, Pune-412 115 Through The Director ‘Symbiosis Institute of Computer Studies and Research, Pune 1, KULKARNI AISHWARYA UDAYAKUMAR, Age 24 Yrs, son/ daughter of SUKANYA and UDAYAKUMAR, resident of _ PUNE Maharashtra India secking provisional admission for the academic year 2020 - 2021 in Master of sine Administration (Information Technology) programme at Symbiosis I € PAU Airy cake SS ae a —— 26 AUG 20 anife fertrComputer Studies and Research, Pune (hereinafter referred to as Constituent), which is a Constituent of Symbiosis Intemational (Deemed University), Pune (hereinafter referred to as SIU), do hereby solemnly affirm, state and declare as under: - 1] THAT, I have furnished the true facts in the online application for entrance test’ selection process (group exercise! personal interaction! writing ability test studio test admission’ finance/ examination and shall abide by the Rules(s)’ Guidelines(s)/ Process(s) prescribed and as amended time to time therein, 2] THAT, I have gone through the admission and eligibility rules of the University for the Master of Business Administration (Information Technology) programme: and that, I also have read carefully the applicable eligibility criteria for the said programme which isas below: (D Graduate from any recognised University/ Institution of National Importance with a ‘minimum of $0% marks or equivalent grade (45% marks or equivalent grade for Scheduled Caste / Scheduled Tribes). (ii) Candidate appearing for final year examinations can also apply, but his/her admission will be subjected to ihe submission of mark sheets of qualifying qualification and passing/ degree certificate with minimum of 50% marks or equivalent grade (45% or equivalem grade for Scheduled Castes/ Scheduled Tribes) at graduation from recognized university/Institutions of National importance within the stipulated time. (iii) Candidates possessing the required educational qualification from any foreign board? university accredited by an Assessment and Accreditation Agency which is ‘approved, recognized or authorized by an authority, established or incorporated under @ law in its home country or any other statutory authority in that country for the purpose of assessing, accrediting or assuring quality and standards of educational institutions will be considered equivalent to required qualifying qualification of an Indian Institution and therefore shall be eligible for admission to Master of Business Administration (Information Technology). 3] THAT, I am aware, I shall NOT be eligible for admission to a Master of Business ‘Administration (Information Technology) unless 1 successfully complete 3/4/5 years of an undergraduate degree and! or eamed prescribed number of credits for an undergraduate degree, through the examinations conducted by a University/ ‘Autonomous Institution or possesses such qualifications as recognised by the concerned University as equivalent to an undergraduate degree. 4] THAT, I undertake to submit following documents for scrutiny of eligibility and confirmation of provisional admission in originals for verification and have also noted the last date to produce applicable documents in original/ self-attested photocopy: (DX th Standard Mark List* (1) XII th Standard Diploma Mark List* (AD) Statement of Marks of all Semesters/Trimesters/ Years of Qualifying Examination* a (IV) Migration Certificate issued by last attended University/ Institution in original*® oo (V) Transference’ Leaving Certificate issued by last attended Insttute/ University in original (Vi) Passing Certificate/ Pro (VID Caste Centificate*# (Vitt) Category Certificate #* (2% Domicile Certificate (If applicable) : (X) Gap Certificate (break before or after college’ university during which students engage in various educational and developmental activities, such as travel or some type of regular work) #* (XI Experience Certificate #* | (XID Registration Certificate (wherever required by respective council) #* Kitt) Bonafide Certificate (if applicable) . (XIV) Certificate of Change in Name issued by Appropriate Authority# (XV) English Test (XV1 Passport (Only for International Students)* (XVID PIO Card (Only for International Students)* (XVID OCT Card (Only for International Students)* (XIX) Nepal/ Bhutan Citizenship Card #* (0X) Visa! Residential Permit #* 2ofS(XXD Equivalence of qualification issued by ized body/ authorit (XXII) AADHAR Card#t a (XXIID Photo Identity Proof (Driving License / PAN Card/ P roof (Driving Lie: ‘ard/ Passport or any other such document as proof of identity issued by Govt. Authority)# (XXIV) Entrance Test Admit Card (If applicable)? (XXV) Entrance Test Score Card (If applicable) (XXVD Selection Process (GE/PI-WAT) Admit Card (If applicable) (XXVID Anti-Ragging Affidavit Student)” CORI Ant-Ragging Affidavit (Pren)™ lemnification/ Healthcare, Recreation and Sports Undertakin; (Student)* ne (XXX) Indemnification/ Healthcare, Recreation and Sports Undertaking (Parent)* (XXXD) Medical Undertaking* (XXXID Application for Provisional Admission (XXXIID) SIU Eligibility Form ( Mandatory) (if epplicable) 4.1 THAT, I undertake to produce all the original documents for security and verification on the day of commencement of the programme. 4.2 THAT, | undertake to apply to the concerned Board/ University immediately, if 1 do not produce any of the above document(s) mentioned above and submit by extended due date, 4.3 THAT, | am aware that failing to produce above mentioned documents and obtain Eligibility Certificate in the stipulated time, I will not be permitted to appear first and or subsequent semester/ annual examination(s) and I authorize Constituent/ Department University to cancel my admission, 5] THAT, I confirm, the facts mentioned below are correct and complete: (a) Academic 7 Mode of Education] Board” Year of | Percentage” Qualification | (Regular/ Distance)| Universit Passing | Grade XII Standard/ Diploma Bachelor Degree) oar Savitribai Phule ala (applicable) [Reet Pune University [721808 Master Degree applicable) Pre Doctoral Degree (if applicable)’ (MPhil) 6] THAT, I authorize the Institute/ University to confirm facts submitted and documents produced by me from previously attended School/ College/ University/ Institute or from any other appropriate body/ authority. 7) THAT, Lam aware, ofthe rules, procedures and requirements of the eligibility process and agree to abide by the decision related to my eligibility. I shall fulfill the Eligibility criteria set by the University/ Constituent for the programme I have applied for. 8) THAT, Ihave carefully read and understood the details given in the prospectus and noted the rules, the process of admission and the rules pertaining to refund of fees as ‘given in the prospectus and shall in matter of interpretation accept the decision given by the Registrar of SIU/ Director of the Constituent in every respect as final and binding. I ‘am well aware of the Non Refundable component of fees. If I cancel my admission, 1 will give notice to the Constituent well in advance and abide by the process laid down by SIU. 9) THAT, L agree to pay the fees regularly as per the schedule informed to me. I a that a fing of Rs 100/- per day will be applicable after the due date of payment of tuition/ hostel/ mess fees. In case of non-payment of fees by the due date, I shall accept any decision / action take by the University. 10) THAT, I am aware of rules, STU/ Constituent has got the right to cancel my incase of situations like, Non-submission of eligibility documents in 3ofSstipulated time, Non-Pa eportn ne, yyment of fees for more than one semester and / or Ni i to the Consttu it ior inimaton in wing to the ia ai cosine for more than 30 days, without prior intimation in writing to the 11] THAT, I shall take note of all communicatic i i i junication sent to me by post/ courier/ email/ ¢ Notice Board ofthe Institut! Hostel (as applicable from time to time)and follow the same and act accordingly. I understand SIU / Symbiosis Institut of Compater Studies im » Pune will not be res i fe ssponsible for delays of any kind due to reasons 12] THAT, if there is any change in facts submitted by jor! duri ; 3 yy me prior! during/ after studentship, T agree to inform the Consituend) Deparmend Unveniy at mats possible. 13] THAT, I declare, I am not pursuing any other degree programme from this University or any other University/ Institution in regular/ distance/ online mode simultaneously, and if | am found pursuing the same, it will be subjected to the rules of University Grants Commission and/ or the concemed Statutory Body and violation if any in this regard will be under the disciplinary action 14] THAT, I understand that I should have minimum mandated attendance in theory and practical classes (if applicable for the programme) of the semester to be eligible to appear for examinations and or placements (if applicable). I understand that, in this regard, if my attendance is less than 75%, I will be given a TNG (Term Not Granted) or CNG (Course Not Granted) as the case may be. 15] THAT, I undertake to attend and/ or participate in all the curricular/ co-curricular extra-curricular sessions/ activities, seminars, conferences & guest lectures which are considered for summer! final placement. 16] THAT, I have read and understood Examination Rules of the University and Section III-10 regarding resorting to unfair means during examinations and Section II-1.1C regarding validity of terms of the Master of Business Administration (Information Technology) and shall abide by the same. demic fees for the Semester! Year, 1 will 17) THAT, 1 am aware, if I don’t pay the aca tions and my result will not be permitted to register and appear for Term End Examina not be declared. 18] THAT, I agree to pay the revised fees as per the University rules with respect 10 cea ination fess (backlog fees/ revaluation fees/ practical fees/ late fees! super late fees Ticable), convocation fees, transcript fees, attestation fees, fees for issuing of documents (degree! diploma certificate’ grade sheet statement of marks, camcolidated grade sheet/ consolidated statement of marks/ passing certificate! hall ticket te), review of answer script postal/ courier charges, if any, et. ‘THAT, I am aware that the University do not have any provision for inter institate 4 will not claim for any reason(s) whatsoever. involve myself directly or indirectly in any kind of RAGGING 20 ties inside or outside Symbiosis Institute of Computer Studies and Research, Pane campus. 1am fully aware that I will be liable for action under relevant penal law/ ‘Tam found to be a part of any ragging activity. ragging law in case 21) THAT, I declare Ihave read the Hostel rules and undertake to aide bythe same (9 21) TT vail hostel accommodation). If | fail to do so, the University’ Constituent has the ‘ibn to take action as per rules and regulations and code of conduet of SIL/ Symbiosis Tustitute of Computer Studies and Research, Pune, 19] transfer an 20) THAT, I will not 22) THAT, 1 undertake that, I will not indulge in any action of using technology and) of 2a iddia causing disrepute to institution! students, hurting sentiments of other sets, abusive in nature, abusing, amounting to racial. discrimination or ‘mora! rasta or any such effort which i prohibited under any law in Indi: and i am found $2Biving in such acts Iwill be Liable for srt disciplinary action which may lead to indi of my admission, I further undertake that 1 will not indulge in any act of vermiape or fand misconduct, and if 1 am found to be involved in any act of indisiPling or misconduct, I am aware tha I shall face the consequences for the same 4of5and I am also aware that if fine is imposed for the act of indisciplir i th amount wl be recovered fom he scary cence a nd ise 23) THAT, | undertake that, during the course of my studentship st Symbiosis, 1 would not cary! Possess) consume aleohol or any drug that is banned/ prohibited or directly or bey, a abet consumption or possession or delivery of such alcohol or drug on 3 not ent i under i a eo {ymbiosis Campus under influence of alcohol or any | 24) THAT, 1am aware, shall NOT be cle for he award ofthe Master of Business Iministration (Information Technology) degree unless I have successfully ! courted the programme with minimum requirements prescribed for the award of Sc. 25) THAT, | shall/ have read and understand! understood the Rules(s)/ Guidelines(s)’ Process(s)/' Code of Conduct governing curricular/eo-currcular/ extra-curricular activities as prescribed by the University and its Constituent’ Department/ Sponsoring a and amendment(s) therein from time to time, and shall undertake to abide by em; 26] THAT, I submit the above information is correct and complete in all respects. That if any of the information is found to be false, concealed, incomplete, misleading and/ or that T fail to disclose all the information and/ or suppress any information and/ or misrepresent the information, the University shall be free to take any action, including withdrawal of my provisional admission at any stage/ time and/ or any other action as deemed fit against me according to the law of judicature. 1 ACCEPT THAT, ALL THE DISPUTES WILL BE SUBJECT TO EXCLUSIVE JURISDICTION OF PUNE, MAHARASHTRA, INDIA ONLY. Name of Applicant: KULKARNI AISHWARYA UDAYAKUMAR Category: Open / General SNAPISCIE ID: 200132938 GE-PIWAT NAD ID: P.R.No: 20030141003 Batch: 2020 - 2022 Programme: Master Of Business Administration (information Technology) ‘Name of Constituent Symbiosis Institute Of Computer Studies And Research, Pune ‘Mother's First Name:SUKANYA, Father's First Name: UDAYAKUMAR, Contact No.: 7385152773, 9156975620 Permanent Address of Student: PUNE Maharashtra India 7 2 ‘Signature of Applicant: ee Name: KULKARNI AISHWARYA UDAYAKUMAR 76 Dated: 14/09/2020 i Deponent wo ‘Signature. oF Wines 6 ‘Gignature OF the Pareni(s)/Guardian(=)) Name: (r+ LEDAZACY MBE ANAM Dated: 14/09/2020 srPpo ure en! Solemnly affirmed and signed before me by the Deponent andl Wwitness/paren(s)/guardian(s) on this - day of 16/9 /2020at mypofiseg= Cy Fg j\y FRLH, Chan d— ‘CHAUDHARI RAKSHA HARI NOTARY GOVT. OF INDIA PUNE CITY (MAHARASHTRAY Regn. No. 20369 Exo. Dt. 87/03/2025 Noted and Roglateres atSeriakwbS 2//2020 ‘16 SEP 2020