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PRO FORMA – I (FOR TYPE – C CANDIDATES) (FOR SONS AND DAUGHTERS OF CENTRAL GOVERNMENT / GOVERNMENT OF INDIA UNDERTAKING EMPLOYEES) Outward No.: …………………………… Date: …../…..../20…..… CERTIFICATE This is to certify that Shri/ Smt. ………………………….……… is an employee in the capacity of ………………………….in ……………………...……………………. (Designation) (Name of the Organization/Establishment/Department) This Organization/ Establishment/ Department is under …………………………… (Department of Central Government/ Government of India undertaking) Shri/ Smt. …………………………………….. is transferred to …………………in Maharashtra State vide transfer order No……………………….. Dated……………… He / She has joined duty in Maharashtra on …………………. and is currently working in the same post. This certificate is issued for the purpose of his/ her son/ daughter ……………….’s admission to First Year of Degree course in Engineering and Technology for the academic year 20…….. - 20……….. (Signature) Place: Name & Designation of the Head of the office Seal of the Office Note: This pro-forma is to be accompanied by attested copy of: 1. Transfer order. 2. Joining report.

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P R O F O RM A – I ( F O R TY PE – C C A N D ID ATES)

(FO R SO N S AND D A UGH TER S O F C EN TRAL GO VE RN M E NT / GO VERNM ENT O F IND IA U N D E R TAKING E M P LO YEES)

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Shri/ Smt. ………………………….……… is an employee in

the capacity of ………………………….in ……………………...……………………. (Designation) (Name of the Organization/Establishment/Department)

This Organization/ Establishment/ Department is under …………………………… (Department of Central Government/ Government of India undertaking)

Shri/ Smt. …………………………………….. is transferred to …………………in

Maharashtra State vide transfer order No……………………….. Dated………………

He / She has joined duty in Maharashtra on …………………. and is currently

working in the same post.

This certificate is issued for the purpose of his/ her son/ daughter ……………….’s

admission to First Year of Degree course in Engineering and Technology for the

academic year 20…….. - 20………..

(Signature) Place: Name & Designation

of the Head of the office Seal of the Office

N o t e : This pro-forma is to be accompanied by attested copy of:

1. Transfer order. 2. Joining report.

P R O F O RM A – I I ( F O R TY PE – D C A N D I D ATES)

(FO R S O NS A N D D A UGH TER S O F M A H ARA SHTR A S TATE G O VE RNM EN T/M A HA RASH TRA S T A TE G O V ERN M E NT U N D ER TAKING E M P LO YEE S)

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Shri/ Smt. …………………………….……… is an employee in

the capacity of …………………………….in …………………...……………………. (Designation) (Name of the Organization/Establishment/Department)

This Organization/ Establishment/ Department is under …………………………...… (Department of Maharashtra State Government / Maharashtra State Government

undertaking.)

Shri/Smt. ………………………………….. is transferred to/from………………

In/out of Maharashtra State vide transfer order No……………………

Dated…………………

He/ She has joined duty in/out of Maharashtra State on …………………. and is

currently working in the same post.

This certificate is issued for the purpose of his/ her son/ daughter ……………….’s

admission to First Year of Degree course in Engineering and Technology for the

academic year 20…….. - 20………..

(Signature) Place: Name & Designation

of the Head of the office Seal of the Office

N o t e : This pro-forma is to be accompanied by attested copy of:

1. Transfer order. 2. Joining report.

P R O F O RM A – I II ( F O R TY PE – D C A N D I D ATES)

(FO R S O NS A N D D A UGH TER S O F M A H ARA SHTR A S TATE G O VE RNM EN T/ M A H A R ASH TRA S TA TE G O V ER NM ENT U ND E RTAKING R ETIRE D E M P LO YE ES)

Date: …../…..../20…..…

U N D ERT AKING

This is to undertake that I, ……………………………………….., have retired from

the service from the post of ……………………. in ……..…………………………… (Designation) (Name of the Organization /Establishment / Department)

This Organization/ Establishment/ Department is under …………………………… Department of Maharashtra State Government / Maharashtra State Government undertaking.

I have retired on…………. and settled in………. taluka…………. district………….

This undertaking is submitted for the purpose of my son/daughter……………..’s

admission to First Year of Degree course in Engineering and Technology for the

academic year 20…….. - 20………...

(Signature) Place: Name ……………………

N o t e : This pro forma is to be accompanied by attested copy of:

1. Pension Pay Order. 2. Proof of settlement (Ration Card/ Electricity Bill/Aadhaar Card/ Telephone Bill/ Property Document/ Election Card).

P R O F O RM A – I V ( F O R D SP-1 , D SP - 2 A ND D SP - 3 C A ND ID A TES)

(FO R S O NS A N D D A UGH TER S O F D EFEN CE S ERVIC E P E RSO N NE L)

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Shri. / Smt ……………………………………………………….

(Full Name of the Employee with Rank of the employee) is/ has been a member of Armed forces of India. He/ She has put in ……………..

years of service in Indian Army/ Indian Navy/ Indian Air Force from

……………… to …………….. and is currently working/ retired from services on

…………….. / permanently disabled since ………………… / killed in action on

…………….…….

This certificate is issued for the purpose of his/ her son/ daughter

………………….’s admission to First Year of Degree course in Engineering and

Technology for the academic year 20…….. - 20………...

(Signature) Place: Name and designation

of the Authority not below the rank of Commandant or equivalent / District Sainik Welfare officer

Seal of the Office

N o t e : 1. This certificate is n o t to be issued for the Civilian Staff working in the Indian Army/Navy/Air force. 2. For DSP-1 and DSP-2 candidates, above pro forma is to be accompanied by attested copy of D o m ic ile ce rt if ica t e o f p a re n t w h o is in a c t iv e s e rv ice o r e x-s e rv ice m an.

P R O F O RM A – V

( F O R D SP-3 C AN DID ATES)

(FO R S O NS A N D D A UGH TER S O F A C TIVE D E FE NC E S ERV ICE P E RSO NNE L N O T D O M ICILE D I N M A H A RASH TRA STA TE)

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Shri/ Smt. …………….…………………………… is a member

of

(Full Name of the Employee with Rank of the employee) Armed forces of India, and is currently working in Indian Army/ Indian Navy/ Indian

Air Force.

Shri / Smt. ………………………………….. is transferred to ………………. (Place of

posting) in Maharashtra State vide transfer order No………………………

Dated………. He/ She has joined duty in Maharashtra on …........……………….

(Date of Joining) and is currently working in the same post.

This certificate is issued for the purpose of his/ her son/ daughter

………………….’s admission to First Year of Degree course in Engineering and

Technology for the academic year 20…….. - 20………..

(Signature) Place: Name & Designation

of the Head of the office Seal of the Office

N o t e : This pro-forma is to be accompanied by attested copy of:

1. Transfer order. 2. Joining report.

This certificate is not to be issued for Civilian Staff working in the Indian Army/Navy/Air force.

P R O F O RM A – V I

( F O R D SP - 3 C AN D ID ATES)

(FO R S O NS A N D D A UGH TER S O F A C TIVE D E FE NC E S ERV ICE P E RSO NNE L N O T D O M ICILE D

I N M A H A RASH TRA STA TE B U T R E TAINED T H EIR FA M ILY A C C O M M O D A TIO N)

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Shri/ Smt. …………….………………………… is a member of

(Full Name of the Employee with Rank of the employee) Armed forces of India, and is currently working in Indian Army/ Indian Navy/ Indian

Air Force.

Shri/ Smt. ………………………………….. is presently posted at ………..…………

(Place of posting)

His/ Her previous posting was at ……………………in Maharashtra State.

He/ She has retained family accommodation in……………………… in

Maharashtra State on account of posting in non-family station/ for education

purpose of son/ daughter.

This certificate is issued for the purpose of his/ her son/ daughter

………………….’s admission to First Year of Degree course in Engineering and

Technology for the academic year 20…….. - 20………..

(Signature) Place: Name & Designation

of the Head of the office Seal of the Office

N o t e : This certificate is not to be issued for Civilian Staff working in the Indian Army/ Navy/ Air force.

P R O F O RM A – VII

( F O R P -1, P -2, A N D P -3 C A ND ID ATES)

(FO R P E R SO NS W ITH D ISABILITY C AN D ID A TES)

Name and address of the Institute / Hospital

Certificate No…………… Date…………

DISABILITY CERTIFICATE

This is certified that Shri/Smt./Km…………………………………… son/ wife/ daughter of

Shri …………………………………….. age………….. sex…………… identification mark

(s)…………………………. is suffering from permanent disability of following category :-

A. Locomotors or cerebral palsy:

(i) BL-both legs affected but not arms.

(ii) BA-Both arms affected (a) Impaired reach (b) Weakness of grip

(iii) BLA-Both legs and both arms affected

(iv) OL-One leg affected (right or left) (a) impaired reach (b) Weakness of grip (c) Ataxic

(v) OA-One arm affected (a) impaired reach (b) Weakness of grip (c) Ataxic

(vi) BH-Stiff back and hips (Cannot sit or stoop)

(vii) MW-Muscular weakness and limited physical endurance

B. Blindness or low vision

(i) B-Blind (ii) PB-Partially Blind

C. Hearing impairment

(i) D-Deaf (ii) PD-Partially Deaf

(Delete the category, whichever is not applicable) 2. This condition is progressive/non-progressive/likely to improve/not likely to

improve. Re-assessment of this case of not recommended/is recommended after a

period of ………years …………months*.

3. Percentage of disability in his/her ………….. percent

case is meets the following physical requirements for discharge :

4. Sh./Smt./Kum……………………………… discharge…………………… of his/her duties.

(i)

F-can perform work by manipulating with fingers

Yes/No

(ii) PP-can perform work by pulling and pushing Yes/No (iii) L-can perform work by lifting Yes/No

(iv) KC-can perform work by lifting Yes/No

(v) B-can perform work by bending Yes/No

(vi) S-can perform work by sitting Yes/No

(vii) ST-can perform work by standing Yes/No

(viii) W-can perform work by walking Yes/No (ix) SE-can perform work by seeing Yes/No

(x) H-can perform work by hearing/speaking Yes/No

(xi) RW-can perform work by reading and writing Yes/No

(Dr…………………… ) (Dr…………………… ) (Dr…………………… )

Member, medical Board Member, medical Board Member, medical Board

Countersigned by the Medical Superintendent/CM O/ Head of Hospital

(with seal) * Strike out which is not applicable

Recent Photograph

of the candidate

showing the

Disability duly

attested by the

chairperson of the

P R O F O RM A–VIII ( F O R P ERSO N W I TH D I SA BILITY C AN D IDA TES)

P 3 (L E A RN ING D ISABILITY) C A ND ID ATE S

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

Name : ………………………………………………….

Age : ………………………………………………….

Date of Birth : ………………………………………………….

Date of Registration: …………….…………… L.D. No.: …………………..………….

Father’s Name : ……….........................…………………..……………………….

Std.: …..……. School Name: …………………………...………………………...……..

Physical & Neurologic Assessment (Date: …………………)

Psychologic Assessment (Date: …………………)

WISC ( R ) Verbal IQ : ………………………………….

Performance IQ : ………………………………….

Global IQ : ………………………………….

Interpretation: ……………………………….………...…………………………………….

Educational Assessment (Date: ……………………) WRAT: R: …………….…………

S: …………….…………

A: …………….…………

Certified that: 1. The percentage of Challenged is not less than 40% and is equal to ………..….%.

2. The disability is permanent in nature.

3. The candidate is capable of carrying out all activities related to theory and practical works as applicable to degree course in Engineering/Technology without any special concessions and exemptions.

4. This Certificate is issued as per the provisions given in the Person with Disability Act, 1995 and its amendments.

This certificate is issued for the purpose of his/ her admission to First Year of

Degree course in Engineering and Technology for the academic year 20…….. -

20………..

Recommendations: ……..…………………………………………………………………….

(Name and Signature of Issuing Authority)

Seal of the Office

Photograph of the

candidate

P R O F O RM A – I X

(FO R C A N D ID A TES FR O M M AH AR ASHTR A A N D K ARN ATAKA D ISPU TED B O RD ER A REA )

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Shri/ Smt. ………………………………… (candidate

himself/ herself) is a resident of………….…..… Village in………..……

Taluka……………. District. This village is a village which exists in Maharashtra

Karnataka disputed border area.

This certificate is issued for the purpose of his / her ward’s / candidate’s

admission to First Year of Degree course in Engineering and Technology for the

academic year 20…….. - 20……….

Place:

District Collector/ Deputy Commissioner/ District

Magistrate/Additional District Magistrate/Taluka Executive Magistrate

Seal of the Office

P R O F O RM A – X

(FO R C A N D ID A TES FR O M M AH AR ASHTR A A N D K ARN ATAKA D ISPU TED B O RD ER A REA )

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Mr. /Miss ……………………………………………. is a

student of this school/ College. He/ She has passed Std. X/ Std. XII/ Diploma/

B. Sc. examination from this school/college located in Maharashtra Karnataka

disputed border area. His/ Her mother tongue is Marathi and he/ she has passed

Std. X/ Std. XII examination with Marathi as one of the subjects.

This certificate is issued for the purpose of his / her admission to First Year of

Degree course in Engineering and Technology for the academic year 20....- 20….

Place:

Head Master/ Principal School/ College

Seal of the School / College

P R O F O RM A – X I

(FO R S O NS A N D D A UGH TER S O F D EFEN CE / P AR AM ILITAR Y FO R CE/ I .A.S./ I .P .S. / I .F .S./ J& K P O L I CE O FFICIA LS P O STE D IN JAM M U/ K ASH M IR T O C O M BAT T E RRO RIST A C TIVITIES)

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Shri/ Smt. ………………………………………….. is an official

belonging to Defence/ Paramilitary force/ I.A.S./ I.P.S./ I.F.S./ J& K Police presently

posted and working at………………………………….. which is treated as disturbed area

in Jammu & Kashmir.

This certificate is issued for the purpose of his/her son/daughter

……………………….…………….’s admission to First Year of Degree courses in

Engineering and Technology for the academic year 20…....- 20……..

Place:

Head of the Office Seal of the Office

P R O F O RM A – X II

(FO R JA M M U/ K ASH M IR M IG RAN T C AN D ID A TES) (M I G RA NTS S TAYING IN R EFUGE E C A M PS)

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Mr./ Miss. ………………………………………….. belongs to

a family residing in this refugee camp after being displaced after 1990 due to

terrorist activities in Jammu and Kashmir. The detail of refugee status is as under.

Ration card Number:……………………………………………………..

Name of the members on the ration card:………………………………..

This certificate is issued for the purpose of his / her admission to First Year of Degree

courses in Engineering and Technology for the academic year 20…....- 20……...

Place:

Name & Signature of Head of the Office Migrant/Refugee Camp

Seal of the Office

P R O F O RM A – X III

( F O R R EF UGEES STA Y ING W ITH R ELATIV ES)

(D I SPL ACE D JAM M U/ K ASH M IR C A ND ID ATE S STA YIN G W ITH R E LATIVE S/ FR I E ND S I N I ND IA O TH ER TH AN M IGR ANT/ R E FU GE E C A M P )

Outward No.: …………………………… Date: …../…..../20…..…

C ERT IFICAT E

This is to certify that Mr./ Miss. ………………………………………….. is a displaced

person from Jammu & Kashmir after 1990 due to terrorist activities in Jammu and

Kashmir. He/ She is staying with ………………………………………………………

(Name and complete address of the Person with whom the candidate is staying at present)

since past ………..years.

This certificate is issued for the purpose of his/ her admission to First Year of Degree

courses in Engineering and Technology for the academic year 20…....- 20……....

Place:

Name & Signature of District Collector

Seal of the Office

[Page: 1/2]

PRO FO RMA – XIV - हमीपत्र (कमीत - कमी रुपये शंभरच्या नॉन ज्युडीशीयल स्टॅम्पपेपरवर खाली नमूद केलेले हमीपत्र सादर करावे)

मी, …………………………………………………………………… (विद्यार्थ्ाांचे नाि)

असे हमीपत्र देतो की, मला डॉ. विश्वनाथ कराड एम.आय.टी.-विश्वशाांती विद्यापीठ, पुणे या

विद्यापीठात राखीि प्रिर्ााच्या कोट्यातून प्रिेश वमळण्यासाठी जात/ जमात िैधता पडताळणी

प्रमाणपत्राची, नॉन विमेलीअर प्रमाणपात्राची (Caste/ Trible Validity Certificate, Non-

Creamy Layer Certificate) आिश्यकता आहे, तथावप जात/ जमात िैधता पडताळणी

प्रमाणपत्राची, नॉन विमेलीअर प्रमाणपात्राची (Caste/ Trible Validity Certificate, Non-

Creamy Layer Certificate) सध्या आमच्याकडे उपलब्ध नाही, ते प्राप्त करण्यासाठी सांबांधीत

विभार्ाकडे अजा दाखल केलेला असून त्याची पािती सोबत जोडलेली आहे. जर मला/ माझ्या

पाल्याला डॉ. विश्वनाथ कराड एमआयटी-विश्वशाांती विद्यापीठ, पुणे येथे प्रथम वर्ष पदवी

अभिय ांभिकी/ थेट भितीय वर्ष पदवी अभिय ांभिकी/ प्रथम वर्ष पदव्युत्तर पदवी

अभिय ांभिकी या अभ्यासिमासाठी विद्यापीठाच्या प्रिेश प्रवियेमधून प्रिेश वमळाला तर जात/

जमात िैधता पडताळणी प्रमाणपत्र, नॉन विमेलीअर प्रमाणपात्र (Caste/ Trible Validity

Certificate, Non-Creamy Layer Certificate) आम्ही, प्रिेश झालेल्या डॉ. विश्वनाथ कराड

एमआयटी-विश्वशाांती विद्यापीठ, पुणे याांचेकडे प्रिेश झाल्या पासून एक मवहन्याच्या आत

म्हणजचे वदनाांक …………………... पूिी सादर करु.

जात/ जमात िैधता पडताळणी प्रमाणपत्र, नॉन विमेलीअर प्रमाणपात्र (Caste/ Trible

Validity Certificate, Non-Creamy Layer Certificate), िर वनदेशीत केलेल्या मुदतीत

वमळविण्याची सिास्वी जबाबदारी माझी असेल, विद्यापीठाची नव्हे.

जात/ जमात िैधता पडताळणी प्रमाणपत्र, नॉन विमेलीअर प्रमाणपात्र (Caste/ Trible

Validity Certificate, Non-Creamy Layer Certificate), प्रिेश वमळालेल्या डॉ. विश्वनाथ

कराड एमआयटी - विश्वशाांती विद्यापीठातील सांबांधीत विभार्ात वदनाांक …………………...

पयांत सादर न केल्यास वकां िा माझे प्रमाणपत्र कोणत्याही कारणास्ति वमळण्यास उशीर

झाल्यास पयाायाने प्रथम वर्ष पदवी अभिय ांभिकी/ थेट भितीय वर्ष पदवी अभिय ांभिकी/

प्रथम वर्ष पदव्युत्तर पदवी अभिय ांभिकी अभ्यासिमासाठी वमळालेला प्रिेश रद्दबातल

झाल्यास त्याची जबाबदारी डॉ. विश्वनाथ कराड एमआयटी-विश्वशाांती विद्यापीठ, पुण े याांची

नसून, सदर जबाबदारी सिास्वी आमची राहील.

विद्यार्थ्ााची स्वाक्षरी : …………………………….…… वदनाांक: ………………………

विद्यार्थ्ााचे नाि : ……………………………………….…………………………………

जातीचा प्रिर्ा/ जातीचे नाि: ……………………….…..…………………………………

पालकाची स्वाक्षरी : …………………………….…… वदनाांक: ………………………

पालकाांचे नाि :…………………………………….……………………………….……

[Page: 2/2]

( P R O F O RMA – X V) Format of Certificate by the Employer/Management for Sponsored Candidates

on the firms/ organizations Letter Head

Ref. No.: Date: / /20

TO WHOM SOEVER IT MAY CONCERN

This is to certify that Shri./Smt.__________________________________________ is

working in this firm/ organization as a __________________________________

since _____________ and he/she has completed ______ year[s] of service in our

organization as an employee. He/she is permitted to study for M. Tech. program at

Dr Vishwanath Karad MIT-World Peace University, Pune.

If he/she is admitted to the said program/University, he/she will be permitted to

attend the course as a full-time student during the working hours of the University

till completion of his/her program.

Signature of Employer/Management

Seal of the farm/ organization/ Institute

Important note: As mentioned in the welcome kit [Annexure – III] the candidate who do not have any original certificate they have to submit the following undertaking.

Process: 1. Print undertaking → 2. Fill-up information in undertaking → 3. Signature the undertaking → 4. Upload in the said undertaking at the time of self-registration.

Date: / /20 .

UNDERTAKING FROM APPLICANTS & PARENTS FOR PENDING DOCUMENTS

I, Ms/ Mr. ___________________________________, S/o or D/o._______________________

__________________________ have applied for admission to First Year/

Direct Second Year, __________________________________________________[Course] and

provisionally admitted under OPEN or General/ SC/ ST/ VJ-NT/ OBC/ SBC/ DSP/ J & K/ PH

category to Dr. Vishwanath Karad MIT World Peace University, Kothrud, Pune – 38.

I/We undertake that, the following original documents/ certificates are pending for

submission, and I/We will submit the same by _________________________[date].

1. 10th/SSC Mark Sheet. 2. 12th/HSC Mark Sheet. 3. 12th/HSC Leaving Certificate/

Transfer Certificate. 4. Nationality Certificate. 5. Gap certificate (if applicable).

6. Aadhar Card. 7. Defence Pro-forma (applicable to Defence quota).

8. Migration Certificate (Applicable to other than Maharashtra State Board).

9. Pro-forma and Disability Certificate (applicable to Persons with Disability).

10. J&K Migration certificate (applicable to J & K Migrant Students).

11. Any other applicable Pro-forma[s] (specify here) ________________________________.

In case I/ We fail to submit the pending original documents/certificates by the given date,

as mentioned above or if documents are found ineligible or information provided herein or

in Application Form is found incorrect at any stage; then the university reserves the right

to cancel our admission and can take any other action as deemed appropriate without any

notice to me/ my ward. I/ We shall have no claim for refund of fee or other charges

already paid or whatsoever, against the University. Further, Fee and other charges as

already paid by me shall stand forfeited.

Signature of the Applicant with date Signature of Parent with date

Name: _______________________________Name: _______________________________

Mob.: ________________________________Mob.: ________________________________