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FORM NO NITJSR/ADM/003 jk V h kS ksfxdh laLFkku te ksniqj NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR Jamshedpur 831 014 Jharkhand India Academic session 2015-16 ID No U G Office Use Only UNDERTAKING Medical Facilities Undertaking of awareness of medical facilities at NIT Jamshedpur Dispensary by Parent / Guardian I Father / mother / guardian of Mr. / Ms. JEE Main Roll No. AIR AIR Category hereby declare the following in respect of my ward to be admitted to B. Tech. Hons. Programme of study at NIT Jamshedpur. I am aware of the following facts i The NIT Jamshedpur Dispensary located in the campus and run by NIT Jamshedpur for its community has limited facilities. FORM NO NITJSR/ADM/003 jk V h kS ksfxdh laLFkku te ksniqj NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR Jamshedpur 831 014 Jharkhand India Academic session 2015-16 ID No U G Office Use Only UNDERTAKING Medical Facilities Undertaking of awareness of medical facilities at NIT Jamshedpur Dispensary by Parent / Guardian I Father / mother / guardian of Mr. / Ms. JEE Main Roll No* AIR AIR Category hereby declare the following in respect of my ward to be admitted to B. Tech. Hons. Programme of study at NIT Jamshedpur. I am aware of the following facts i The NIT Jamshedpur Dispensary located in the campus and run by NIT Jamshedpur for its community has limited facilities. ii with chronic or serious ailments. iii In case of emergency I hereby authorize the doctors of Tata Main Hospital TMH Jamshedpur to take decisions in connection with medicine / surgical treatment in the best interest of my son / daughter / ward. iv It is the responsibility of the parents / guardians to take care of their wards for outside treatment. v Each student would be provided a limited health insurance through a professional company. However the dealing with that company would be entirely the responsibility of the student. NIT Jamshedpur in no way would be responsible for any dispute / discrepancy. Despite the best efforts on the part of NIT Jamshedpur if any untoward thing happens to my ward I shall not hold the Institute accountable for the same and will not seek any financial help or compensation for the same through any court of law. FORM NO NITJSR/ADM/003 jk V h kS ksfxdh laLFkku te ksniqj NATIONAL INSTITUTE OF TECHNOLOGY JAMSHEDPUR Jamshedpur 831 014 Jharkhand India Academic session 2015-16 ID No U G Office Use Only UNDERTAKING Medical Facilities Undertaking of awareness of medical facilities at NIT Jamshedpur Dispensary by Parent / Guardian I Father / mother / guardian of Mr. / Ms. JEE Main Roll No* AIR AIR Category hereby declare the following in respect of my ward to be admitted to B. / Ms. JEE Main Roll No* AIR AIR Category hereby declare the following in respect of my ward to be admitted to B. Tech. Hons. Programme of study at NIT Jamshedpur. I am aware of the following facts i The NIT Jamshedpur Dispensary located in the campus and run by NIT Jamshedpur for its community has limited facilities. Tech. Hons. Programme of study at NIT Jamshedpur. I am aware of the following facts i The NIT Jamshedpur Dispensary located in the campus and run by NIT Jamshedpur for its community has limited facilities. ii with chronic or serious ailments. iii In case of emergency I hereby authorize the doctors of Tata Main Hospital TMH Jamshedpur to take decisions in connection with medicine / surgical treatment in the best interest of my son / daughter / ward.

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