FORM-1

FORMAT FOR UP-GRADATION OF CHOICE OF INSTITUTE IN THE

SECOND ROUND OF COUNSELLING

Name of Candidate :- ______________________ JEE ROLL NUMBER:-_____________________

Admission Center:- ________________________________________________________

Sir,

i. I have been allotted seat in the 1st round of Counseling at

___________________________ and I have deposited the amount of Rs. 40,000/-
through On-line Debit/Credit Card/ Netbanking on ______________________ (date &
time) .
ii. I would like to upgrade my choice of Institute for allotment of seat in Second round of
counseling.
iii. I am fully aware that in the event of allotment of seat in the up-graded choice of
Institute in the 2nd round of counseling, I shall have no claim on earlier allotted seat
and it will automatically be cancelled.
iv. Willingness for up-gradation in 2nd round = Yes No

Signature of candidate:- ________________

Date:-____________________
 FORM-2

UNDERTAKING
(For Candidate who has yet to submit passing certificate of 10+2 for various reasons)

I,________________________________________ JEE Roll Number __________________

son/daughter of _____________________________________ state that my result of 10+2
examination is yet to be declared by the Board. I undertake to submit my 10+2 pass certificate on
or before 30th September, 2019 to the allotted Institute.

I understand that my admission is provisional to the allotted institute and is liable to be cancelled in
case of failure to submit the 10+2 pass certificate by 30th September, 2019.

I further understand that in case of cancellation of my provisional admission, I shall have no claim
over refund of fee.

(Parent’s/ Guardian Signature) (Candidate’s Signature)

Date:________________
Address:_________________________

_____________________________

_____________________________
Mobile No:____________________

Email:________________________

For use by Admission Center

Admission Center:__________________________________________________

Name & Signature of Official(ACs)_____________________________________

 FORM-3

WITHDRAWAL/REFUND FEE REQUEST FORM

I want to withdraw from the allotted seat of B.Sc.HHA -2019 at IHM
______________________________. Kindly allow me to withdraw from the allotted Institute and
refund my fee according to NCHM Rule 18.3 of withdrawal / refund policy. I understand that :

i. Seat allotted to me in 1st/ 2nd Cousnelling shall automatically be cancelled as per my

willingness and in future I shall have no claim on this seat.

ii. My fees shall be refunded within 45 days as per the refund policy of NCHMCT.

Roll Number: ________________AIR _______ Name : ________________________________

Father’s Name:____________________ Mob No: _______________2._______________________

Address:
_____________________________________________________________________________

____________________________________________________ PIN __________________

Bank details for refund of fees

1.Name of Account Holder: _______________________________________________________

2.Name of Bank & Branch ________________________________________________________

3. SB A/c Number:_______________________________________________________________

4. IFSC Code _____________________________

(Please attach a copy of cancelled cheque/Passbook & Receipt of Counselling FEE)

(Parent’s Signature) (Applicant Signature)

Mobile: Mobile:
Date: Date:
 FORM-4

UNDERTAKING FOR SUBMISSION OF OBC CERTICATE

I, ____________________________ do hereby undertake that I shall submit OBC(NCL) Certificate

in a prescribed format from the Competent Authority in support of claim of my provisional
admission under OBC(NCL) quota in Central Institute of Hotel Management at
__________________________ at the time of my physical reporting at the above allotted institute
failing which my admission at the said institute is liable to be cancelled for admission under OBC
(NCL) quota and I understand that fees deposited at the admission Centre shall not be refunded to
me.

2. I do hereby undertake that I shall submit OBC (NCL) certificate in a prescribed format issued by
competent authority on or before 30.09.2019 in support of my claim of admission under OBC
(non-creamy layer) quota at Central Institute of Hotel Management at
________________________ failing which my admission is liable to be cancelled and I shall have
no claim of refund of fee.

(Signature)
Name:________________
Roll No:_______________
 Appendix- 1

(FORMAT FOR MEDICAL CERTIFICATE)

CERTIFICATE

(To be completed and signed by a registered MBBS Doctor and presented by the candidate at the time of Admission)

Certified that I have in general and also in regard to following infectious diseases examined
Mr/Ms.__________________(whose signature is given below) Son/Daughter of Sh.________________
Resident of _______________________________________

Disease Finding

a) Infectious skin diseases

b) Psoriasis Foliate

c) Tuberculosis

d) Trachoma

e) Venereal disease

f) HIV

and find that he/ she is not suffering from any of the above diseases.

I also certify that after examination I find that Mr./ Ms. _________________ is fit to undergo course of
study in Hospitality and Hotel Administration.

_______________ ________________

(Signature of Candidate) (Signature of Registered Medical

Practitioner)

Seal _____________________

Registration No:_______________
 APPENDIX -2

(Prescribed Format for OBC Certificate)

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR APPOINTMENT TO POSTS /
ADMISSION TO CENTRAL EDUCATIONAL INSTITUTIONS (CEIs), UNDER THE GOVERNMENT OF INDIA

This is to certify that Shri / Smt. / Kum. __________________________________________________________ Son / Daughter of

Shri /Smt. ____________________________________________________________________ of
Village/Town________________________________________District/Division __________________________________ in the
State/Union Territory _________________________ belongs to the __________________________Community which is
recognised as a backward class under the Government of India, Ministry of Social Justice and Empowerment’s Resolution No.
____________________________________ dated ______________*. Sh/ Smt/ Kumari
______________________________________________ and /or his/her family ordinarily reside(s) in the
_______________________________ District/ Division of the _____________________________ State/ Union Territory. This is
also to certify that he/she does not belong to the persons/ sections (Creamy Layer) mentioned in Column 3 of the Schedule to the
Government of India, Department of Personnel & Training O.M. No. 36012/22/93-Estt.(SCT) dated 08/09/93** .

Dated: _________________

District Magistrate /

Deputy Commissioner etc.

Seal

__________________________________________________________________________________________

NOTE:

*The authority issuing the certificate may have to mention the details of Resolution of Govt of India, in which the caste of the
candidate is mentioned as OBC.

**As amended from time to time.

Note: The term “ Ordinarily” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950.

This certificate should not be issued earlier than one year, should be issued after April-2018 onwards .
 Appendix- 3
Government of …………………………………………………
_____________________________________________________
________________________________________________
(Name & Address of the authority issuing the certificate)

INCOME & ASSET CERTIFICATE TO BE PRODUCED BY ECONOMICALLY WEAKER SECTIONS

Certificate No:________________________
Date:_____________

VALID FOR THE YEAR _____________________

THIS is to certify that Shri/Smt/Kumari _________________________________________

son/daughter/wife of ______________________________ is permanent resident of
______________________________Village/ Street____________________________ Post Office
______________________ District :_________________ in the State/Union Territory PIN
CODE________________ whose photograph is attested below Economically Weaker Sections, since the
gross annual income* of his/her “’family’” ** is below Rs.8 lakh(Rupees Eight Lakh only) for the financial
year. His/her family does not own or possess any of the following assets***

i. 5 acres of agricultural land and above;

ii. Residential flat of 1000 sq ft and above
iii. Residential plot of 100 sq yards and above in notified municipalities
iv. Residential plot of 200 sq yards and above in acres other than the notified municipalities

2. Shri/Smt/Kumari _____________________________ belongs to the _________________________

caste which is not recognized as a Scheduled Caste, Schedule Tribe and Other Backward Classes (Central
List).

Signature with seal of office…………………………………………….

Name:………………………………………………………………….
Designation:……………………………………………….
Recent Passport
size attested
photograph of
applicant

_______________________________________________________________________________________
*Note 1: Income covered all sources i.e. salary, agriculture, business, profession etc.

**Note2: The term ‘Family” for this purpose will include the person, who seeks benefit of reservation
his/her parents and siblings below the age of 18 years as also his/her spouse and children below the age of
18 years.

***Note3:The property held by a ‘Family” in different locations or different place/cities have been clubbed
while applying the land or property holding test to determine EWS status.
INCOME AND ASSET CERTIFICATE ISSUING AUTHORITY AND VERIFICATION OF CERTIFICATE

1. The benefit of reservation under EWS can be availed upon production of an Income and Asset
Certificate issued by a Competent Authority. The Income and Asset Certificate issued by any one of
the following authorities in the prescribed format as given in Annexure-I shall only be accepted as
proof of candidate’s claim as belonging to EWS :-

(i) District Magistrate/ Additional District Magistrate/ Collector/ Deputy Commissioner/

Additional Deputy Commissioner/ 1s* Class Stipendiary Magistrate/Sub-Divisional
Magistrate/ Taluka Magistrate/ Executive Magistrate/ Extra Assistant Commissioner.
(ii) Chief Presidency Magistrate/ Additional Chief Presidency Magistrate/ Presidency
Magistrate.
(iii) “Revenue Officer not below the rank of Tehsildar and,
(iv) Sub-Divisional Officer or the area where the candidate and/ or his family normally resides.

2. The Officer who issues the certificate would do the same after carefully verifying all relevant
documents following due process as prescribed by the respective State/ UT.

3. The crucial date for submitting income and asset certificate by the candidate may be treated as the
closing date for admission i.e.30.09.2019, except in cases where crucial date is fixed otherwise.

4. The admission authorities should, in the offer of admission to the candidates claiming to the
belonging to EWS, include the following clause :-
“The admission is provisional and is subject to the Income and asset certificate being verified
through the proper channels and if the verification reveals that the claim to belong to EWS is
fake/false the admission will be cancelled forthwith without assigning any further reasons and
without prejudice to such further action as may be taken under the provisions of the Indian Penal
Code for production of fake/false certificate.”
The admission authority should verify the veracity of the Income and asset certificate submitted by
the candidate through the certificate issuing authority.

5. Instructions referred to above should be strictly followed so that it may not be possible for an
unscrupulous person to secure admission on the basis of a false claim and if any person gets an
admission on the basis of such false claim, his/her admission shall be cancelled invoking the
conditions contained in the offer of admission.