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DR. BH IM RAO AMBEDKAR UN IVERSITY AGRADepartrhent of Physica I Ed ucation

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DR. BH tM RAO AMBEDKAR U N IVERSITY' AGRA

Deparlrhent of Physical Ed ucatton&SPorts

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P{.-

DR. BH I M RAO AM BEDKAR U N IVERSITY, AG RADepaftrhent of Physical Education

&Sports

Letter

Date

Seal

Paste your

attested,

recent photo

Name of College

Date

Name of Box6r

Date of Birth

I hereby declare, that when entering boxing in Inter collegiate Boxing

(Women) Championship 2016-17 organized by D r. B.R. Ambedkar University, Agra

from l7-L0-I6 to 18-10-16, I am not pregnant, and I have had a pregnancy test done

within 14 days and that result of the test shoiled NO PREGNANCY.

Signed in the presence of :

Boxer's Signature Signature of Asstt. P roff./Secretary

Name

Designation

Seal

Inter Collegiate Boxing $D Championship

20t6-17

TINDERTAKING

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