AP EAMCET 2016: PROFORMA FOR UNDERTAIKNG IN THE FORM OF AFFIDAVIT

U N D E R T A K I N G

I, Mr/Ms ……………………………………………………………………………………….

S/o / D/o…………………………………………………………………, bearing AP EAMCET
Rank No ………………………….. and AP EAMCET Hall Ticket No.…………………………
give undertaking as below, in connection with my claim under Area Status (Study
certificates/Residence certificate) and Caste Category for admission into MBBS / BDS Courses
for the Academic Year 2016-17.

        I am aware that the relevant certificate (s) is / are found to be not genuine at a later
date, I forego the seat allotted in my favour. Further I agree that I abide the Rules and
Regulations and I am liable for criminal prosecution, as may be deemed fit.

        I also hereby undertake that I shall not enter into legal litigation, if the seat allotted to
me is cancelled, for the above reasons.

Signature of the Parent / Guardian                                                             Signature of the Candidate

Aadhar No.                                                                                                  Aadhar No.
Name:
                                                                                                                     Rank No.
                                                                                                                     Place: H.T. No.
                                                                                                                     Date: Address :