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Information Brochure
B.Tech Admission 2018-19
Indian Institute of Technology Tirupati Renigunta Road, Tirupati – 517 506
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506
Dear Student,
Greetings and good wishes to you on behalf of the IIT Tirupati.
We warmly welcome you to IIT Tirupati and congratulate you for gaining admission into one of India’s most
prestigious higher technical Institutions. We wish to make your experience most fulfilling and wonderful
phase in your life.
Schedule of activities:
Date Event Venue
07-08-2018 Reporting for
Hostel admission
For Boys
Boys Hostel, IIT Tirupati Permanent Campus, Yerpedu – Venkatagiri
Road, Yerpedu (1.5 Kms from Yerpedu Main Junction).
Contact persons: Mr. Ramesh Krishnan – 8333904912
Mr. Janakiraman - 8333987911
For Girls
Girls Hostel, Lakshminagar Colony (Near Temporary Campus),
Renigunta Road, Tirupati – 517 506.
Contact person: Mrs. Pushpalatha - 9502361362
08-08-2018 Orientation and
admission
Academic Building, IIT Tirupati (Permanent Campus),
Yerpedu-Venkatagiri Road.
09-08-2018 to
11-08-2018 Induction Program
Academic Building, IIT Tirupati (Permanent Campus),
Yerpedu-Venkatagiri Road.
13-08-2018 Commencement of
Classes
Academic Building, IIT Tirupati (Permanent Campus),
Yerpedu-Venkatagiri Road.
(Buses will be arranged from Girls hostel to Institute)
The last date for enrolment with fine of Rs. 2000/- is 16-08-2018
Students should produce the following documents in original for verification during Admission on
08.08.2018 (Tuesday):
a) Provisional Admission letter
b) Original Admit Card JEE (Advanced) 2018
c) Original Certificate of Date of Birth, 10th class and 12th class or equivalent
d) If you belong to DS/SC/ST/OBC-NCL category or PwD, the category and/or PwD certificate as per the format in
the JOSAA portal.
e) The students belonging to most economically backward (whose family income is less than Rs. 1.00 lakh per annum)
and other economically backward (whose family income is between Rs.1.00 lakh and Rs.5.00 lakhs per annum)
have to obtain Income certificate in the Form A/B (Annexure III) and apply for the fee remission in the prescribed
Form (Annexure VII) and submit the same in original for verification at the time of admission i.e., on 08-08-2018
failing which they are not eligible for Tuition fee concession as indicated in the fee structure.
Students should submit the following at the time of admission:
a) Scholarship application form [MCM Scholarship (Annexure IV A) SC/ST Scholarship (Annexure IV B)] along
with income certificate Form A/B (if eligible).
b) Medical Examination Report (Annexure V) – Test reports not required
c) Solemn Affirmation of conformance to rules and regulations, Anti-ragging Self and Parent (Annexure VI)
d) Transaction details for online fee payment
We look forward to meet with you and your parents/guardian at the time of orientation on 08-08-2018.
With best wishes
Prof. K. Krishnaiah
Dean Academic Affairs
Indian Institute of Technology Tirupati Renigunta Road, Tirupati – 517 506
Fee Structure – B.Tech (2018 Batch)
First Semester (July-Dec 2018)
S.No Item of Fee & Deposits Value in Rs.
I. Institute Fees
SC/ST/
PwD
Income
Above 5
Lakhs
Income
between 1
to 5 Lakhs
Income
below 1
Lakh
A. One Time Fees (during admission)
1. Admission fee 150 150 150 150
2. Grade card fee 150 150 150 150
3. Provisional certificate 100 100 100 100
4. Medical Exam fee 100 100 100 100
5. Student welfare fund 1000 1000 1000 1000
6. Modernization fee 300 300 300 300
7. Alumni Life Membership Fee (NS) 1000 1000 1000 1000
8. Publication Fee (NS) 250 250 250 250
Total A 3050 3050 3050 3050
B. Semester Fees
1. Tuition Fee 0 100000 33334 0
2. Examination Fee 350 350 350 350
3. Registration – Enrolment Fee 200 200 200 200
4. Gymkhana Fee 1250 1250 1250 1250
5. Medical Fee 700 700 700 700
6. Student Wellness Fee 100 100 100 100
7. Medical Insurance Premium 1100 1100 1100 1100 8. Hostel Seat Rent * 5000 5000 5000 5000
9. Fan, Electricity & Water charges * 750 750 750 750
Total B 9450 109450 42784 9450
C. Deposits (refundable)
1. Institute Deposit 1000 1000 1000 1000
2. Library Deposit 1000 1000 1000 1000
Total C 2000 2000 2000 2000
Total Institute Fee for Hostellers (A+B+C) 14500 114500 47834 14500
Total Institute Fee for Day-Scholars [A+(B-*)+C+II(3)] 14750 114750 48084 14750
II. Hostel & Mess Charges for GE/OBC/ and SC/ST/PwD
1. Admission Fee 250
2. Hostel Deposit (NS)-(refundable) 3000
3. Estt. “A” Charges 6000
4. Estt. “B” Charges 1500
5. SWD 50
6. Advanced Dinning charges 22750
Total 33550
NS - Non-Statutory fees
* - For Hostellers only
All the students shall have access to interest free loan under Vidyalaxmi scheme
Students who paid more than Institute fees applicable to them as indicated above at the time
of seat Acceptance need not pay any fee at the time of admission.
Hostel rooms are allotted on sharing basis. If you wish to be a dayscholar, you should register your
name in the Office of the Associate Dean Students and obtain dayscholar certificate immediately after
admission.
Annexure I A
3
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506
Details of fee payable various categories of students
S.No Fee Particulars
Institute Fee Hostel
Fee Due Hosteller Day Scholar
Total Due Total Due
(1) (2) (3) (4) (5) (6) (7)
1 SC/ST/PwD Students 14500 1000 14750 1250 33550
2
Most economically backward
students (whose family income is
less than 1 lakh per annum)
14500 (-) 19000 14750 (-) 18750 33550
3
Other economically backward
students (whose family income is
1 lakh to 5 lakh per annum)
47834 14334 48084 14584 33550
4 All other students (whose family
income above 5 lakhs per annum) 114500 81000 114750 81250 33550
Seat acceptance fee of Rs.13500/- (SC/ST/PwD) and Rs.33500/- (for others) has already been paid*.
The balance fee to be paid is shown in column number (4) and (6) of above table. Extra payment made
by the students as shown in column number (4) and (6) with minus (-) sign will be credited to the
student’s bank account after admission.
* Rs.1500/- deducted towards processing fee for document verification at reporting centre.
Fees should be paid only through online. DD is not acceptable.
Online payment link: https://www.onlinesbi.com/prelogin/icollecthome.htm?corpID=646389
Note: Candidates can pay the fee online with effect from 16-07-2018 onwards.
Annexure I B
4
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506
Statement of Expenditure for B.Tech Programme
(Students’ whose family income is above 5 lakhs per annum)
The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.
S.No Particulars Value in
Rs.
1. Admission/1st semester fee (including insurance) 1,12,500
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 1,08,350 x 7 7,58,450
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 12,16,950
13. Semester abroad programmes** 4,00,000
Grand Total 16,16,950
* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.
** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean in these cases. Student may be permitted to avail this
additional loan provision with the production of: (i) Letter of permission from host University and (ii)
Letter of permission from the respective Dean of IIT Tirupati.
Academic Section
Annexure II A
5
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506
Statement of Expenditure for B.Tech Programme
(Students’ whose family income between Rs.1 Lakh to Rs.5 Lakhs per annum)
The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.
S.No Particulars Value in
Rs.
1. Admission/1st semester fee (including insurance) 45,834
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 41,684 x 7 2,91,788
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 6,83,622
13. Semester abroad programmes** 4,00,000
Grand Total 10,83,622
* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.
** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean in these cases. Student may be permitted to avail this
additional loan provision with the production of: (i) Letter of permission from host University and (ii)
Letter of permission from the respective Dean of IIT Tirupati.
Academic Section
Annexure II B
6
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506
Statement of Expenditure for B.Tech Programme
(Students’ whose family income is below Rs.1 Lakh per annum)
The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.
S.No Particulars Value in
Rs.
1. Admission/1st semester fee (including insurance) 12,500
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 8,350 x 7 58,450
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 4,16,950
13. Semester abroad programmes** 4,00,000
Grand Total 8,16,950
* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.
** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean in these cases. Student may be permitted to avail this
additional loan provision with the production of: (i) Letter of permission from host University and (ii)
Letter of permission from the respective Dean of IIT Tirupati.
Academic Section
Annexure II C
7
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI
Renigunta Road, Tirupati – 517 506
Statement of Expenditure for B.Tech Programme
(All SC, ST, PwD students’ irrespective of parental Income)
The following statement of expenditure is issued to facilitate for availing Bank Loan/Scholarship.
Fees and Statement of Expenditure for B.Tech. Programme and other charges/expenses for the
students to be admitted in the Academic year 2018-19.
S.No Particulars Value in
Rs.
1. Admission/1st semester fee (including insurance) 12,500
2. Caution deposit (Institute & Library) 2,000
3. Fees payable from 2nd to 8th Semester @ Rs. 8,350 x 7 58,450
4. Annual Medical Insurance Premium for 3 years at the rate of Rs. 1200/- * 3,600
5. Hostel Caution Deposit 3,000
6. Hostel Admission Fee @ Rs. 250/- per semester for 8 semesters 2,000
7. Hostel Establishment ‘A’ charges @ Rs. 6,000/- per semester for 8 semesters* 48,000
8. Hostel Establishment ‘B’ charges @ Rs. 1,500/- per semester for 8 semesters* 12,000
9. Solid Waste Disposal charges @ Rs.50/- per semester for 8 semesters 400
10. Text books & stationery (approx..) 40,000
11. Laptop computer 75,000
12. Boarding & Lodging charges for 4 years* 1,60,000
Total 4,16,950
13. Semester abroad programmes** 4,00,000
Grand Total 8,16,950
* For budgetary purposes, calculations are based on rate during current academic year 2018-19 and for
subsequent years, a nominal increase in charges have been accounted for.
** A few students who are academically performing well are permitted by the Institute to pursue one or
two semesters in a foreign University with which IIT Tirupati has an MoU for doing courses and or project.
Specific permission letter will be given by Dean in these cases. Student may be permitted to avail this
additional loan provision with the production of: (i) Letter of permission from host University and (ii)
Letter of permission from the respective Dean of IIT Tirupati.
Academic Section
Annexure II D
8
FORM A
INCOME CERTIFICATE FROM THE HEAD OF THE OFFICE WHERE FATHER AND/ OR MOTHER /GUARDIAN OF THE STUDENT IS EMPLOYED
(This certificate is to be produced by Father /Mother /Guardian who are working in Government/ Public sector organisation.)
Certified that the annual income of Shri / Smt. _____________________________________
(Father / Mother / Guardian) employed in this office as ______________________________
including special pay, etc. during the year 2017-2018 (July 2017–June 2018) is as given below:
Sl. No. Item Total in (July 2017 to June 2018)
1 Basic Pay (including special pay, NPA etc.)
2 D.A.
3 C.C.A.
4 Deputation allowance
5 Special Pay
6 Honorarium
7 Bonus
8 Other allowances, if any
Total
Place : Signature of the Head Office / Department Date :
(This certificate is not valid without the office seal) Note: Separate certificate has to be given for father & mother
(if father and mother are employed)
Annexure III
9
FORM B
INCOME CERTIFICATE FROM THE REVENUE OFFICIAL NOT BELOW THE RANK OF THASILDAR OR MAGISTRATE CLASS I OF THE AREA WHERE THE
FATHER AND/OR MOTHER/LEGAL GUARDIAN OF THE STUDENT RESIDES
(This certificate is to be produced by Father /Mother /Guardian who are self-employed as Doctor/ Lawyer/Businessman/Agriculturist/Private employment, etc.)
Certified after having fully satisfied myself that the income of
Shri/Smt._________________________________________ Father/ Mother/ Guardian of the
student residing at ___________________________________________________________
______________________________is ______________ for the period from July 2017 to
June 2018 as detailed below:
Sl.No. Item Total Annual Income in `. (July 2017 to June 2018)
1 Professional Income (Doctor, Lawyer, etc.)
2 Agricultural Income
3 Interest from Bank deposits
4 Dividend from shares
5 Other income (give details such as House rent income etc.)
Total
Signature of Father :
Mother :
Date : Signature of the Revenue Official Not below the rank of Tahsildar/ Magistrate Class I
Place :
(This certificate is not valid without the official seal) Note : Separate certificate has to be given for father and mother if both have separate
sources of income.
10
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI APPLICATION FORM FOR MCM SCHOLARSHIP
(This form is to be filled in by B.Tech students whose parents’ annual income is less than Rs.4.50 lakhs during July 2017 to June 2018)
1. Name of the student (in block letters) :
Roll No. :
Hostel Address :(If day scholar, give present address)
2. Category : GE / OBC / PD-GE/ PD-OBC (enclose copy of certificates if any)
3. Date of Birth :
4. Place, District and State of birth :
5. Permanent address :
6. Parent’s Occupation (Please tick whichever is applicable)
Sl.No Job Father Mother Guardian
1 Govt. job / Company job
2 Self-employment : Lawyer/Doctor/ Business/ Agriculture, etc.
Parent’s Mobile No. :
Student Mobile No & e-mail ID :
Contd….
Annexure IV A
11
- 2 -
7. Income in Rupees:
Sl.No Income thro’ Father Mother Guardian
1 Salary/Pension
2 Self-employment: Profession/ Business/ Agriculture/ Others (specify)
3 Other Income: Rent/Interest on Investment, etc.
The above income must be authenticated as follows: • Salary/Pension – Employer’s certificate in Form A has to be given (If father and
Mother are employed, two separate certificate have to be given) • Agriculture / House Income / Business/Consultancy / Doctor / Lawyer /
Professional Practice – Thasildar’s certificate in Form B has to be given
8. Have you applied for (or) getting any other Scholarship : Yes / No
If yes, from which Organisation ? :
What is the amount per annum : `.
We hereby declare and affirm that the above statement made by us is correct to the best of our knowledge. In case any of the particulars furnished by us are found to be incorrect at a later date, we will be liable to refund the scholarship amount already received.
(Signature of the Parent) (Signature of the Student)
Place : Date :
STUDENT UNDERTAKING
Certified that Shri/Ms Roll No. ------------------ is not in receipt of Scholarship from any other sources.
Date Signature Name : Hostel & Room No :
12
FORM A
INCOME CERTIFICATE FROM THE HEAD OF THE OFFICE WHERE FATHER AND/ OR MOTHER /GUARDIAN OF THE STUDENT IS EMPLOYED
(This certificate is to be produced by Father /Mother /Guardian who are working in Government/ Public sector organisation.)
Certified that the annual income of Shri / Smt. _____________________________________
(Father / Mother / Guardian) employed in this office as ______________________________
including special pay, etc. during the year 2017-2018 (July 2017–June 2018) is as given below:
Sl. No. Item Total in (July 2017 to June 2018)
1 Basic Pay (including special pay, NPA etc.)
2 D.A.
3 C.C.A.
4 Deputation allowance
5 Special Pay
6 Honorarium
7 Bonus
8 Other allowances, if any
Total
Place : Signature of the Head Office / Department Date :
(This certificate is not valid without the office seal) Note: Separate certificate has to be given for father & mother
(if father and mother are employed)
13
FORM B
INCOME CERTIFICATE FROM THE REVENUE OFFICIAL NOT BELOW THE RANK OF THASILDAR OR MAGISTRATE CLASS I OF THE AREA WHERE THE
FATHER AND/OR MOTHER/LEGAL GUARDIAN OF THE STUDENT RESIDES
(This certificate is to be produced by Father /Mother /Guardian who are self-employed as Doctor/ Lawyer/Businessman/Agriculturist/Private employment, etc.)
Certified after having fully satisfied myself that the income of
Shri/Smt._________________________________________ Father/ Mother/ Guardian of the
student residing at ___________________________________________________________
______________________________is ______________ for the period from July 2017 to
June 2018 as detailed below:
Sl.No. Item Total Annual Income in `. (July 2017 to June 2018)
1 Professional Income (Doctor, Lawyer, etc.)
2 Agricultural Income
3 Interest from Bank deposits
4 Dividend from shares
5 Other income (give details such as House rent income etc.)
Total
Signature of Father :
Mother :
Date : Signature of the Revenue Official Not below the rank of Tahsildar/ Magistrate Class I
Place :
(This certificate is not valid without the official seal) Note : Separate certificate has to be given for father and mother if both have separate
sources of income.
14
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATI APPLICATION FORM FOR SC/ST SCHOLARSHIP
(This form is to be filled in by B.Tech students whose parents’ annual income is less than Rs.4.50 lakhs during July 2017 to June 2018)
1. Name of the student (in block letters) :
Roll No. :
Hostel Address :(If day scholar, give present address)
2. Category : SC / ST / PD-SC/ PD-ST (enclose copy of certificates if any)
3. Date of Birth :
4. Place, District and State of birth :
5. Permanent address :
6. Parent’s Occupation (Please tick whichever is applicable)
Sl.No Job Father Mother Guardian
1 Govt. job / Company job
2 Self-employment : Lawyer/Doctor/ Business/ Agriculture, etc.
Parent’s Mobile No. :
Student Mobile No & e-mail ID :
Contd….
Annexure IV B
15
- 2 -
7. Income in Rupees:
Sl.No Income thro’ Father Mother Guardian
1 Salary/Pension
2 Self-employment: Profession/ Business/ Agriculture/ Others (specify)
3 Other Income: Rent/Interest on Investment, etc.
The above income must be authenticated as follows: • Salary/Pension – Employer’s certificate in Form A has to be given (If father and
Mother are employed, two separate certificate have to be given) • Agriculture / House Income / Business/Consultancy / Doctor / Lawyer /
Professional Practice – Thasildar’s certificate in Form B has to be given
8. Have you applied for (or) getting any other Scholarship : Yes / No
If yes, from which Organisation ? :
What is the amount per annum : `.
We hereby declare and affirm that the above statement made by us is correct to the best of our knowledge. In case any of the particulars furnished by us are found to be incorrect at a later date, we will be liable to refund the scholarship amount already received.
(Signature of the Parent) (Signature of the student)
Place : Date :
STUDENT UNDERTAKING
Certified that Shri/Ms. Roll No. ------------------ is not in receipt of Scholarship from any other sources.
Date Signature : Name : Hostel & Room No :
16
FORM A
INCOME CERTIFICATE FROM THE HEAD OF THE OFFICE WHERE FATHER AND/ OR MOTHER /GUARDIAN OF THE STUDENT IS EMPLOYED
(This certificate is to be produced by Father /Mother /Guardian who are working in Government/ Public sector organisation.)
Certified that the annual income of Shri / Smt. _____________________________________
(Father / Mother / Guardian) employed in this office as ______________________________
including special pay, etc. during the year 2017-2018 (July 2017–June 2018) is as given below:
Sl. No. Item Total in (July 2017 to June 2018)
1 Basic Pay (including special pay, NPA etc.)
2 D.A.
3 C.C.A.
4 Deputation allowance
5 Special Pay
6 Honorarium
7 Bonus
8 Other allowances, if any
Total
Place : Signature of the Head Office / Department Date :
(This certificate is not valid without the office seal) Note: Separate certificate has to be given for father & mother
(if father and mother are employed)
17
FORM B
INCOME CERTIFICATE FROM THE REVENUE OFFICIAL NOT BELOW THE RANK OF THASILDAR OR MAGISTRATE CLASS I OF THE AREA WHERE THE
FATHER AND/OR MOTHER/LEGAL GUARDIAN OF THE STUDENT RESIDES
(This certificate is to be produced by Father /Mother /Guardian who are self-employed as Doctor/ Lawyer/Businessman/Agriculturist/Private employment, etc.)
Certified after having fully satisfied myself that the income of
Shri/Smt._________________________________________ Father/ Mother/ Guardian of the
student residing at ___________________________________________________________
______________________________is ______________ for the period from July 2017 to
June 2018 as detailed below:
Sl.No. Item Total Annual Income in `. (July 2017 to June 2018)
1 Professional Income (Doctor, Lawyer, etc.)
2 Agricultural Income
3 Interest from Bank deposits
4 Dividend from shares
5 Other income (give details such as House rent income etc.)
Total
Signature of Father :
Mother :
Date : Signature of the Revenue Official Not below the rank of Tahsildar/ Magistrate Class I
Place :
(This certificate is not valid without the official seal) Note : Separate certificate has to be given for father and mother if both have separate
sources of income.
18
Medical Examination Report
Medical History and personal particulars of Students joining at IIT Tirupati
1. Full Name (in capitals) …………………………………………………..………………………
2. JEE (Adv) 2018 Roll No. …………………………… IITT Roll No.……..…………………
3. Name of Parent/Guardian ………………………………………………………………………..
4. Personal : Veg. / Non-Veg.
Abuse of substances (if any) : Smoking / Alcohol / Drugs / Any other
5. Past Medical/Surgical Treatment : No Yes
5.1 Allergies/Bronchial Asthma/Tuberculosis
5.2 Abdomen including Urinary Tract
5.3 Locomotor system (Spinal/Vertebral column/Joints)
5.4 Cardiovascular system
5.5 Neurological disorders/Psychological disorders
5.6 Sexually-transmitted/Venereal Diseases/Skin
5.7 Hepatitis
5.8 Diabetes
5.9 Rheumatism
5.10 Thyroid disease
6. Family history of any major illness : No Yes
6.1 Tuberculosis
6.2 Leprosy
6.3 Diabetes
6.4 Hypertension
6.5 Ischemic heart diseases
6.6 Psychiatric illness
6.7 Cancer
7. Identification marks : 1)
2)
8. Blood Group :
I declare that all the statements above are true and correct to the best of my knowledge. I fully understand that I am responsible for the accuracy of all statements given.
Candidate’s Signature : ………………………………………………………………………….
Counter signed by Parent/Guardian………………………………………………………………….
Date :
Place : P.T.O. (2)
CONFIDENTIAL Annexure V
19
: 2 :
HEALTH CERTFICATE
1. Examination by a General Physician (M.D. in General Medicine)
I, Dr. ……………………………………………………………………………………………………
after examining (with necessary investigations) Mr./Ms. ……………………………………………
Son / Daughter of Mr./Ms. ……………………………………………………………………………….
born on …………………………
CERTIFY:
Weight ………. Kg. Height ………. cm. Blood Pressure ………….. /…………. mm Hg.
Girth of Chest : (a) At rest ……………………. : (b) After deep inspiration ………………………..
Cardiovascular System : Heart ………………… Heart Sounds ……………
Respiratory System :
Neurological System :
Psychological disturbance : Yes / No If yes, specify ………………………………….
Past Medical or Surgical Record :
Identified allergies :
Current treatments :
Current vaccination Status (All candidates who do not have adequate active/passive immunity against diseases mentioned below should take these injections/adult booster dose as recommended, just before joining the Institute and the date to be mentioned below):
VACCINATION AGAINST DISEASES
1st Injection Last Booster Date Yes / No Date Yes / No
BCG
Diphtheria – Tetanus - Poliomyelitis
Measles, Mumps, Rubella
Hepatitis B
Hepatitis A
Meningitis
Typhoid
Chicken Pox
Influenza Vaccine (H1N1)
Candidate’s Signature : …………………………………………………………….
P.T.O. (3)
20
: 3 : INVESTIGATIONS
1. *Electrocardiogram Date ……………………….. Result ………………………
2. *Chest X-ray Date ……………………….. Result ………………………
3. *Sonography (whole abdomen) Date ……………………….. Result ………………………
4. *Urine Date ………………………. Result ………………………
5. *Blood Tests Date ……………………….. Result ………………………
a) Blood Sugar (F/PP) Date ……………………….. Result ………………………
b) Urea/Creatinine Date ……………………….. Result ………………………
c) Peripheral Smear Study/HB% Date ……………………….. Result ………………………
d) Lipid Profile Date ……………………….. Result ………………………
e) Blood Group/typing (if not known) Date ……………………….. Result ………………………
f) HBS Ag Date ……………………….. Result ………………………
g) HIV – I & II Date …………………….. Result ………………………
*All original investigation reports (only) to be attached.
Remarks / Special Recommendation, if any:
Conclusion : 1. Fit / Unfit to pursue higher education with a very tight academic schedule. 2. Does not suffer from any seizure disorder and he/she is fit for swimming
Reason :
Date :
Place : Signature & Seal
Candidate’s Signature : …………………………………………………………………………….
P.T.O. (4)
21
: 4 : 2. Examination by Ophthalmologist*
Acuity of Vision
Far Vision Near Vision Colour Vision Naked Eye With Glasses Naked Eye With Glasses
R.E.
L.E.
*Latest Optometrist’s Recommendations, if any to be attached in original.
Remarks / Special Recommendation, if any :
I, Dr. …….…………………………………………………………………………………………….. have examined (with necessary investigations) Mr./Ms. …………………………………………… Son / Daughter of Mr./Ms. ……..……………………………………………………….…………. born on ……………………………… and the above information given to the best of my knowledge are correct and true.
Date :
Place : Signature & Seal
3. Examination by ENT Specialist*
Inspection / hearing *AudiometryRight Ear
Left Ear
*Latest Audiometry report to be attached in original.
Remarks / Special Recommendations, if any.
I, Dr. …….……………………………………………………………………………………….. have examined (with necessary investigations) Mr./Ms. ………………...………………………………… Son / Daughter of Mr./Ms. ……..…………………………………………………..…….…………….
born on ……………………………… and the above information given to the best of my knowledge are correct and true.
Date :
Place : Signature & Seal
Candidate’s Signature : ………………………………………………………………………
22
INDIAN INSTITUTE OF TECHNOLOGY TIRUPATISOLEMN AFFIRMATION OF CONFORMANCE TO RULES AND REGULATIONS
(to be submitted by all Students / Scholars of IIT Tirupati) (TO BE FILLED ALL IN CAPITAL LETTERS)
I, Mr./Ms………………………………………………………………………………………………,
assigned with IIT Tirupati Roll No…………………………………….., am the son/daughter/ward of
Mr./Ms. ……………….………………….……………………………………………………………,
Residing at Door No. ………………………………House No……..……..……………….………….,
Street Name: . ……………………………………………………....……………………...……………,
Local Area Name: . ………………………………………………………………..……………………,
Village/Town/City Name: .……………………………………………………………………….……..,
State: . ……………………………………………………… . Pin code:………………………..……,
am joining as a student of …………………… Programme in Department of ……………….………..,
………………………………………………………
I hereby declare that, I: a) have read and understood the prevailing rules of regulations of the Instituteb) am aware of
(i) The national laws pertaining to ragging,(ii) The serious consequences of this impermissible behavior, and(iii) The administrative, legal and penal actions that will be imposed on persons apprehended,
tried and convicted of this crime; and c) am aware of the ban on the possession and/or use of alcohol or tobacco in any form and any
powered vehicles by students inside the IIT Tirupati Campus.
Keeping the above in mind, I SOLEMNLY AFFIRM that:
a) I SHALL NOT violate the prevailing rules and regulations of IIT Tirupati, my INSTITUTE;
b) I SHALL NOT indulge in ragging, nor will encourage, abet, or be indifferent towards others engagingin ragging; and, on the contrary, will work to ensure the dignity, honour and self-esteem of allstudents;
c) I SHALL NOT possess and/or use any alcohol or tobacco product and powered vehicle inside theIIT Tirupati campus, except with the due permission, if applicable, and that
I understand that if I am found violating or to have violated any of the rules and regulations pertaining to students of IIT Tirupati, I am liable to obey the rulings of the respective official authorities or Committees of IIT Tirupati and/or pay the penalty specified by them.
Signature of Student Counter Signed by Parent/Guardian
Place: TirupatiDate:
Please visit http://iittp.ac.in/images/demo/iit/pdfs/B.Tech-Ordinance-Regulations.pdf
Annexure VI
23
SELF DECLARATION BY THE STUDENT
1) I, ________________________________________________________
_______________________________________________ (Full name of student in CAPITAL letters with
roll number) S/o D/o Shri./ Smt. ___________________________________________
___________________________________________________________ having been admitted to IndianInstitute of Technology Tirupati, have:
(a) Been advised to read carefully and understand the Supreme Court Judgement on Ragging hosted
(b)
(c)
in http://iittp.ac.in/anti-ragging/ Received a copy of the Essential Extracts of relevant Regulations on Curbing the Menace of Ragging in Higher Educational Institutions, 2009, (hereinafter called the relevant Regulation) Carefully read and fully understood the provisions contained therein.
2) I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what constitutes raggingand the implications thereof.
3) I have also, in particular, understood Clause 7 and Clause 9.1 of the relevant Regulations and am fully aware ofthe penal and administrative actions that are liable to be taken against me in case I am found guilty of or abettingragging, actively or passively, or being part of a conspiracy to promote ragging.
4) I hereby solemnly state and undertake that:
a) I will not indulge in any behavior or act that may be considered as ragging under Clause 3 of therelevant Regulations.
b) I will not participate in or abet or propagate through any act of commission or omission that may beconsidered as ragging under Clause 3 of the relevant Regulations.
5) I hereby affirm that, if found guilty of ragging, I am liable for punishment according to Clause 9.1 of the relevantRegulations, without prejudice to any other criminal action that may be taken against me under any penal law orany 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 onaccount 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.
Place:
Date:
Signature of Student
Name: Telephone/Mobile No:
Address:SELF-DECLARATION
Verified that the contents of this self declaration are true to the best of my knowledge and no part of the declaration is false and nothing has been concealed or misstated therein.Place: Date: Signature of Student
24
SELF DECLARATION BY PARENTS/GUARDIANS
1) I, Mr./Mrs./Ms. _______________________
_________________ (Titles, Full name of Parents/Guardians in CAPITAL letters)
Father / Mother / Guardian of Mr. / Ms. ___________________________________________________
________________________________________________ (Full name of student in CAPITAL letters
with Roll number) who has been admitted to Indian Institute of Technology Tirupati have:
(a)
(b)
(c)
Been advised to read carefully and understand the Supreme Court Judgement on Ragging hosted in http://iittp.ac.in/anti-ragging/ Received a copy 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.
2) I have, in particular, understood Clause 3 of the relevant Regulations and am aware as to what constitutesragging and the implications thereof.
3) I have also, in particular, understood Clause 7 and Clause 9.1 of the relevant Regulations and am fullyaware of the penal and administrative actions that are liable to be taken against my ward in case he/she isfound guilty of or abetting ragging, actively or passively, or being part of a conspiracy to promote ragging.
4) I hereby solemnly state and undertake that:
a) My ward will not indulge in any behavior or act that may be considered as ragging under Clause 3of the relevant Regulations.
b) My ward will not participate in or abet or propagate through any act of commission or omissionthat may be considered as ragging under Clause 3 of the relevant Regulations.
5) I hereby affirm that, if found guilty of ragging, my ward is liable for punishment according to Clause 9.1 ofthe relevant Regulations, without prejudice to any other criminal action that may be taken against my wardunder 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 thecountry on account of being found guilty of, abetting or being part of a conspiracy to promote ragging, andfurther affirm that, in case this declaration is found to be untrue, my ward’s admission is liable to becancelled.
Signature of Father/Mother/Guardian
Name:
Telephone / Mobile No.Address:
SELF DECLARATION by PARENTS/GUARDIAN
Verified that the contents of this self declaration are true to the best of my knowledge and no part of the self declaration is false and nothing has been concealed or misstated therein.
Place: Date:
Signature of Father/Mother/Guardian
25
To
The Registrar
IIT Tirupati
Sir,
Sub: Application for Remission of Fee
(For those students whose parental income is less than Rs. 5 (Five) lakhs per annum)
This is to inform you that my family income from all source is Rs. ______________ / (in words Rupees
_____________________________________________) for the financial year 2017-18. In support of
my claim Form-A along with a copy of IT Return for the assement year 2017-18 is enclosed.
OR
I am not required to file IT return in accordance with Income Tax Act 1961, therefore I am enclosing
Income certificate in Form - B issued in the last six months by the Revenue Officer.
---------------------------------------------------------------------------------------------------------------------------
(strike out which is not applicable)
I further declare that the above information is true to the best of my knowledge and belief and I am
aware that I am solely responsible for the correctness and accuracy of the above declaration and
understand that providing false information amounts to miscounduct and may lead to cancellation of
admission at IIT Tirupati. I further authorize IIT Tirupati to verify my income.
Accordingly, I request you to kindly exempt me from paying tuition Fee as indicated below.
(1) Rs. 1,00,000/- (Family Income less than Rs. 1,00,000/- per annum.)
(2) Rs. 66,666/- (Family Income less between Rs. 1,00,000/- and Rs. 5,00,000/-)
---------------------------------------------------------------------------------------------------------------------------
(strike out which is not applicable)
Student’s Signature : ___________________ Parent’s Signature : ___________________
Name : ___________________ Name : ___________________
Roll No. : ___________________ Address : ___________________
Department : ___________________ : ___________________
Address : ___________________ PAN : ___________________
: ___________________ UID : ___________________
PAN : ___________________ Bank A/C No : ___________________
UID : ___________________ Date : ___________________
Bank A/C No : ___________________ Place : ___________________
Date : ___________________
Place : ___________________
Annexure VII
26