APPLICATION FOR CONFIRMATION OF ELIGIBILITY AND PROVISIONAL ADMISSION

FOR THE ACADEMIC YEAR: 2022-2023

To

The Registrar
Symbiosis International (Deemed University)
Gram: Lavale, Tal: Mulshi, Pune-412 115

Through
The Director
Symbiosis Institute of International Business
G. No. 174/1 Hinjewadi, Taluka - Mulshi,
Pune - 411057

I, DAIDA CHAKRADHAR , age 24 yrs., son/ daughter of DAIDA SAIDIAH & DAIDA KAVITHA, resident of H.NO 7-101,
OPP CENTENARY BAPTIST CHURCH, VEMULAPALLI, NALGONDA, Telangana - 508217 seeking provisional
admission for the academic year 2022-23 in Master of Business Administration (Agri Business) programme at
Symbiosis Institute of International Business (hereinafter referred to as Constituent), which is a Constituent of
Symbiosis International (Deemed University), Pune (hereinafter referred to as SIU), do hereby solemnly affirm, state
and declare as under: -

1] THAT, MY ADMISSION IS PROVISIONAL AND SUBJECT TO FULFILLMENT OF ALL THE ELIGIBILITY

CONDITIONS, AS LAID DOWN IN THE ELIGIBILITY RULES OF THE SYMBIOSIS INTERNATIONAL (DEEMED
UNIVERSITY) (SIU) FOR THE PROGRAMME TO WHICH I HAVE BEEN PROVISIONALLY ADMITTED. I ALSO
2] 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.

3] THAT, the admission is being offered to me on the basis of information furnished and documents submitted by me.

4] THAT, SIU may cancel my admission at any stage/ time, if it is revealed that admission has been secured by
using fraudulent means or in case of any information or particulars found wrong/ false or any fact concealed and I shall
have no claim what-so-ever with respect to my admission at any point of time. I understand the SIU/ Constituent may
change or reverse any other decision made on the basis of incorrect or incomplete information submitted by me.

5] THAT, I have gone through the admission and eligibility rules of the University for the Master of Business
Administration (Agri Business) Programme; and that, I also have read carefully the applicable eligibility criteria for the
said Programme which is as below:

Graduate from any recognized University/ Institution of National Importance with a minimum of 50% marks or
equivalent grade (45% for SC/ ST or equivalent grade).

6] THAT, I shall NOT be eligible for admission to Master of Business Administration (Agri Business) Programme
unless I successfully complete 3/4/5 years of an undergraduate degree and/ or earned 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.

7] THAT, I am required 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:

(i) Xllth Standard/ Diploma Mark List*

(ii) Statement of Marks of all Semesters/Trimesters/ Years of Qualifying Examination*
(iii) Migration Certificate issued by last attended University/ Institution in original’
(iv) Transference/ Leaving Certificate issued by last attended Institute/ University in original*
(v) Passing Certificate/ Provisional Degree/ Degree Certificate“
(vi) Caste Certificate”#
(vii) Category Certificate #”
(viii) Domicile Certificate #*
(ix) 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) #“
(x) Experience Certificate #”
(xi) Registration Certificate (wherever required by respective counciI)#*
(xii) Bonafide Certificate (if appIicabIe)#
(xiii) Certificate of Change in Name issued by Appropriate Authority#
(xiv) English Test#
(xv) Passport (Only for International Students)“
(xvi) PIO Card (Only for International Students)”
(xvii) OCI Card (Only for International Students)*
(xviii) Nepal/ Bhutan Citizenship Card #*
(xix) Visa/ Residential Permit #*

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 (xx) Equivalence of qualification issued by recognized body/ authority#
(xxi) AADHAR Card#
(xxii) Photo Identity Proof (Driving License / PAN Card/ Passport or any other such document as proof of identity
issued by Govt. Authority)#
(xxiii) Entrance Test Admit Card (If appIicabIe)#
(xxiv) Entrance Test Score Card (If appIicabIe}#
(xxv) Selection Process (GE/PI-WAT) Admit Card (If appIicabIe)#
(xxvi) Anti-Ragging Affidavit (Student)“
(xxvii) Anti-Ragging Affidavit (Parent)*
(xxviii) Indemnification/ Healthcare, Recreation and Sports Undertaking (Student)*
(xxix) Indemnification/ Healthcare, Recreation and Sports Undertaking (Parent)”
(xxx) Medical Undertaking*
(“ Mandatory) (# if applicable)

7.1 THAT, I am required to produce all the original documents for scrutiny and verification on the day of commencement
of the programme.

7.2 THAT, I will apply to the concerned University/ Board/ Institute immediately, if I do not produce any of the above
document(s). I shall submit the pending document(s) by the given due date.

7.3 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 authorise the University/ Constituent
to cancel my admission.

8] THAT, the facts mentioned below are correct and complete:

(a) Academic Qualifications:-

Qualification Mode of Education Board/ University Year of Passing Percentage/ Grade

(Regular/ Distance)

XII Standard/ Diploma 86.9

Bachelor Degree Acharya N.G. Ranga

(if applicable) Agricultural University

Master Degree
(if applicable)

Pre Doctoral Degree

(if applicable)/
(M.Phil.)

(b) Work Experience (if applicable)

Designation Organization Period Work Experience Organization

(in months) contact details
From To (Email ID, Phone
No. etc.)

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9] THAT, I authorise the University/ Constituent to confirm facts submitted and documents produced by me from
previously attended School/ College/ University/ Institute or from any other appropriate body/ authority.

10] THAT, I am aware of the 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.

11] THAT, I have 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, I will give notice to the
Constituent well in advance and abide by the process laid down by SIU.

12] THAT, I agree to pay the fees regularly as per the schedule informed to me. I agree that a fine of Rs.100/- per day will
be applicable after the due date of payment of academic/ hostel/ mess fees. In case of non-payment of fees by the
due date, shall accept any decision/ action taken by the University including cancellation of admission.

13] THAT, SIU/ Constituent has got the right to cancel my admission in case of situations like, Non-submission of
eligibility documents in stipulated time, Non-Payment of fees for more than one semester and/ or Non-reporting to the
Constituent for more than 30 days, without prior intimation in writing to the concern authority.

14] THAT, I shall take note of all communication sent to me by posh courier/ email/ Institute LMS/ uploaded on the
website of the University/ Institute and/ or affixed on the Notice Board of the Institute/ Hostel [as applicable from time
to time] and follow the same and act accordingly. I understand SIU/ Symbiosis Institute of International Business will
not be responsible for delays of any kind due to reasons beyond its control.

15] THAT, if there is any change in facts submitted by me prior/ during/ after studentship, I agree to inform the
Constituent/ Department/ University as soon as possible.

16] THAT, I am not pursuing any other degree programme from this University or any other University/ Institution in
regular/ distance/ online mode simultaneously, and if I am found pursuing the same, it will be subjected to the rules
of University Grants Commission and/ or the concerned Statutory Body and violation if any in this regard will be under the
disciplinary action.

17] THAT, 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.

18] THAT, upto a maximum of 25% leave of absence (on medical grounds, Institute related work, personal leave
requirements or any emergencies) from lectures is permissible with or without prior sanction of the Director.

19] THAT, I am expected 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.

20] THAT, all orientation programmes/ camps/ seminars/ meets/ workshops/ gym etc. are essential and significant for me,
therefore, I am expected to attend the same as per schedule given. I shall take note of all communication sent to me from
SIU/ Symbiosis Institute of International Business and follow the same from time to time.

21] THAT, I have read and understood Examination Rules of the University and Section III-10 regarding resorting to unfair
means during examinations and Section III-1.1C regarding validity of terms of the Master of Business Administration
(Agri Business) and shall abide by the same.

22] THAT, I am aware, if I do not pay the academic fees for the Semester/ Year, I will not be permitted to register
and appear for Term End Examinations and my result will not be declared.

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23] THAT, I agree to pay the revised fees as per the University rules with respect to examination fess (backlog fees/
revaluation fees/ practical fees/ late fees/ super late fees as applicable), convocation fees, transcript fees, attestation
fees, fees for issuing of duplicate documents (degree/ diploma certificate/ grade sheet/ statement of marks, consolidated
grade sheet/ consolidated statement of marks/ passing certificate/ hall ticket etc.), review of answer script postal/ courier
charges, if any, etc.

24] THAT, I am aware, once the admission process is over for the respective programme, the inter institute transfer is not
permitted for any reason(s) whatsoever.

25] THAT, I will NOT involve myself directly or indirectly in any kind of RAGGING activities inside or outside Symbiosis
Institute of International Business campus. I am fully aware that I will be liable for action under relevant penal law/
ragging law in case I am found to be a part of any ragging activity.

26] THAT, I have read the hostel rules and undertake to abide by the same [as I am availing hostel accommodation]. If I
fail to do so, the University/ Constituent has the right to take action as per rules and regulations and code of conduct
of SIU/ Symbiosis Institute of International Business.

27] THAT, I will not indulge in any action of using technology and/ or social media causing disrepute to institution/
students, hurting sentiments of other students, abusive in nature, abusing, amounting to racial discrimination or moral
turpitude or any such effort which is prohibited under any law in India; and if I am found indulging in such acts, I will
be liable for strict disciplinary action which may lead to termination of my admission. I further undertake that I will not
indulge in any act of indiscipline or /and misconduct; and if I am found to be involved in any act of indiscipline or
misconduct, I am aware that I shall face the consequences for the same; and I am also aware that if fine is imposed
for the act of indiscipline or/and misconduct, the amount will be recovered from the security deposit for any misconduct.

28] THAT, during the course of my studentship at Symbiosis, I would not carry/ possess/ consume alcohol or any drug
that is banned/ prohibited or directly or indirectly, aid & abet consumption or possession or delivery of such alcohol or
drug on campus, and would not enter Symbiosis Campus under influence of alcohol or any prohibited substance.

29] THAT, I will not indulge in any act of indiscipline; and if I found to be involved in any act of indiscipline or misconduct, I
shall face the consequences for the same in accordance with the Symbiosis International (Deemed University) [Code of
Conduct, Procedure to inquire and decide with Misconducts/ Indiscipline by students] Rules, 2019 and amended from
time to time.

30] THAT, I shall NOT be eligible for the award of the Master of Business Administration (Agri Business) degree
unless have successfully completed the programme with minimum requirements prescribed for the award of degree.

31] THAT, I shall/ have read and understand/ understood the Rules(s)/ Guidelines(s)/ Process(s)/ Code of Conduct
governing curricular/co-curricular/ extra-curricular activities as prescribed by the University and its Constituent/
Department/ Sponsoring Society, and amendment(s) therein from time to time, and shall undertake to abide by them;

32] THAT, 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 I 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.

33] THAT, if there is any change in the information furnished, I shall intimate the University/ Constituent from time to time.

34] THAT, ALL THE DISPUTES WILL BE SUBJECT TO EXCLUSIVE JURISDICTION OF PUNE, MAHARASHTRA,
INDIA ONLY.

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Name of Applicant : DAIDA CHAKRADHAR

Category : Scheduled Caste SNAP ID : 220152665

GE-PIWAT ID : 24MAB0406 NAD ID :

P.R.No : 22020242070 Batch : 2022 - 2024

Programme : Master of Business Administration (Agri
Business)
Name of Constituent : Symbiosis Institute of International
Business
Mother’s First Name : DAIDA KAVITHA Father’s First Name : DAIDA SAIDIAH

Contact No. : Contact No. :

Permanent address :

(Signature of the Applicant)

Name : DAIDA

CHAKRADHAR

Dated : 21-Jul-2022

Deponent

Signature of Witness

(Signature of the Parent(s)/Guardian(s))

Name :

Dated :

Solemnly affirmed and signed before me by the Deponent and witness/parent(s)/guardian(s) on this- day of / /20a at
my office.

VERIFIED
BEFORE ME

Notary Public

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