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NATIONAL INSTITUTE OF TECHNOLOGY DURGAPUR MAHATMA GANDHI AVENUE, DURGAPUR – 713209 WEST BENGAL, INDIA

INDEX

ITEM PAGE NO.

FLOW CHART 1

ADMISSION SCHEDULE AND FEES PAYBLE 2

DOCUMENTS REQUIRED 3

PAYMENT OF BALANCE INSTITUTE FEES & MESS CHARGES 4

CERTIFICATE FORMAT 5

INCOME CERTIFICATE ISSUING AUTHORITY 6 -7

FORMAT OF MEDICAL CERTIFICATE 8

FORMAT OF OBC-NCL CERTIFICATE AND NOTIFICATION

NUMBERS

9-10

FORMAT OF SC / ST CERTIFICATE 11

FROMAT OF DISABILITY / DYSLEXIC CERTIFICATE 12-18

FLOW CHART FOR ADMISSION 2018 PHYSICAL REPORTING TIME: 9.30 AM to 3.00 PM (NEW ACADEMIC BUILDING)

DOCUMENTS VERIFICATION (ROOM NO.:O08)

REPORT GENERATION AND COLLECTION

OF GENERATED DOCUMENTS

(CSAB 2018 & NIT DURGAPUR ADMISSION)

(ROOM NO: 001)

ADMISSION COMPLETED

Proceed to Hostel for Room

Allotment (as given in page 4)

PHYSICAL REPORTING FOR ADMISSION (ROOM NO: 004)

ONLINE INSTITUTE REGISTRATIION (ROOM NO: 002)

SIGNATURE & PHOTO SCANNING

(ROOM NO.:002)

B.TECH / DUAL DEGREE INTEGRATED M.Sc

DATES OF ADMISSION & HOSTEL

ALLOTMENT19th July - 23rd July 2018 19th July - 23rd July 2018

FIRST SEMESTER CLASSES

COMMENCE FROM

General / OBC (Categories A, B & C) 35,000 35,000

GEN (PwD) /OBC (PwD) 15,000 15,000

SC /ST 15,000 15,000

General / OBC (Categories A, B ) NIL NIL

General / OBC (Category C) 38,950 38,950

GEN (PwD) / OBC (PwD) NIL NIL

SC/ST NIL NIL

CIWG

DASA (NON SAARC)

DASA (SAARC)

GOI, MEA (WELFARE)

SAARC

NON SAARC

Account Details for Balance Institute fee

deposit (Mode: NEFT/On-Line/ IMPS /

Direct Transfer)

All Categories 15,000 (MESS ADVANCE) + 3,000 (MESS CAUTION MONEY)

MESS FEES TO BE DEPOSITED IN THE RESPECTVE HALL OF RESIDENCE (HOSTEL) MESS ACCOUNT

A/C No : 30759768090, SBI, RE COLLEGE DURGAPUR

BRANCH, IFSC Code: SBIN0002108

INDIAN STUDENTS ADMITTED THROUGH JoSAA 2018

STUDENTS ADMITTED THROUGH DASA 2018 (DATE OF ADMISSION JULY 23-26, 2018)

11,450

11,450

11,450

USD 3500 (Equivalent INR) + INR 11,450

STUDENTS ADMITTED THROUGH GOI, MEA (WELFARE)

73,950

STUDENTS ADMITTED THROUGH GOI, MEA (EDUCATION)

USD 1750 (Equivalent INR) + INR 11,450

NATIONAL INSTITUTE OF TECHNOLOGY DURGAPUR

FEES TO BE DEPOSITED DURING ADMISSION IN THE INSTITUTE ACCOUNT

30 th July 2018

For students to be admitted under JoSAA 2018 in B. Tech / Dual Degree / Integrated M.Sc Programme -

Category A: Parental annual Income up to Rupees One Lakh;

Category B: Parental annual Income up to Rupees Five Lakhs but above Rupees One Lakh;

Category C: Parental annual Income more than Rupees Five Lakhs.

Income Certificate to be issued by the competent authority as per the list given and issued on or after 1st April, 2018 which is

mandatory for Category A and Category B on the date of admission.

Remission of Tuition Fee (for Category A and Category B) will not be allowed for the Academic year 2018-19 if the Income

Certificate issued by the competent authority as per the list and issued on or after 1st April, 2018 is not submitted on the date of

admission.

ADMISSION SCHEDULE AND FEES PAYABLE (in INR) AT THE TIME OF ADMISSION

FOR THE ACADEMIC SESSION 2018-19

FEES DEPOSITED DURING COUNSELING / SEAT ACCEPTANCE FEE

PHYSICAL REPORTING TIME FOR ADMISSION : 9. 30 AM to 3.00 PM (NEW ACADEMIC BUILDING)

NATIONAL INSTITUTE OF TECHNOLOGY DURGAPUR CHECK LIST OF THE DOCUMENTS FOR ADMISSION AT NIT DURGAPUR

B. Tech/ B. Tech and M. Tech (Dual Degree) / Integrated M.Sc. Admission 2018

Sl.

No

Documents Required

(THROUGH CSAB-2018)

1. Document Verification-cum-Seat Acceptance Letter Original+

Photo copy

2. Admit Card for JEE (Main) Examination - 2018 Photo copy

3. JEE (Main) -2018 Results (Score Card) Photo copy

4. Seat Allotment Letter (Final) Photo copy

5. Photo ID Proof as per Govt. of India norms (preferably Aadhaar Card) Original + Photo

copy

6. Certificate of Date of Birth issued by competent authority

7. Mark Sheets of Class XII

8. Medical Certificate as per JoSAA Format (Annexure 8, Business rule of JoSAA) Original

9. Valid Certificate of Category (OBC/SC/ST), if applicable, as per Government of India

Norms, issued by the competent authority, Date of issue should be on or after

01/04/2018)

Original + Photo

copy

10. Undertaking by the candidate regarding OBC status, if applicable Original

11. Certificate for Persons With Disabilities (PwD), if applicable

Original + Photo

copy

12. Proof of payment of Balance Institute fee

Original/

Downloaded copy

13. Copy of the Anti-Ragging Affidavits signed by Students and Parents / Guardians

(http://antiragging.in/site/affidavits_registration_form.aspx)

For filling up the form use the following :

COLLEGE DETAILS: West Bengal/Engineering/NIT Durgapur/NIT Durgapur/YES /Basu/ Prof/

Anupam/Male/343 2546397/Faridpur PS

COURSE DETAILS: Undergraduate Degree/<allotted branch>/< blank>/ 100/4

14. Recent Passport size photograph (2 Nos.)

Documents Required

(Foreign Nationals /International Students [ICCR/DASA/GOI-MEA (W) / GOI-MEA (E)

1. Certificate of Date of Birth issued by competent authority

Original + Photo copy 2. Mark Sheets of Class XII

3. Medical Certificate as per JoSAA Format (Annexure 8, Business rule of JoSAA)

4. Proof of payment of Balance Institute fee Original/ Downloaded

copy

5. Copy of the Anti-Ragging Affidavits signed by Students and Parents / Guardians

(http://antiragging.in/site/affidavits_registration_form.aspx)

For filling up the form use the following :

COLLEGE DETAILS: West Bengal/Engineering/NIT Durgapur/NIT Durgapur/YES /Basu/ Prof/

Anupam/Male/343 2546397/Faridpur PS

COURSE DETAILS: Undergraduate Degree/<allotted branch>/< blank>/ 100/4

6. For foreign Nationals /International Students [ICCR/DASA/GOI-MEA (W) / GOI-MEA (E) : must have

original passport, Citizenship card (for Nepal students)and valid VISA

7. Recent Passport size photograph (2 Nos.)

PAYMENT OF INSTITUTE FEES:

The institute fees payable as mentioned in previous page 2 may be paid before arrival to the

institute for admission.

MODE OF PAYMENT

1. THROUGH SBI COLLECT (BALANCE INSTITUTE FEE):

(LINK : https://www.onlinesbi.com/prelogin/icollecthome.htm) –it will activate soon

2. ON-LINE / NEFT/IMPS/DIRECT TRANSFER/RTGS

ACCOUNT NAME: NATIONAL INSTITUTE OF TECHNOLOGY DURGAPUR,

A/C No. 30759768090, IFSC Code: SBIN0002108,

SBI, R. E. College, Durgapur Branch

3. CASH PAYMENT ONLY AT INSTITUTE BRANCH OF SBI.

PAYMENT OF MESS CHARGES:

HOSTEL FEE: RS.15000/- (MESS ADVANCE) + RS. 3000/- (MESS CAUTION MONEY)

All the students are advised to pay the all mess charges in advance through online mode (NEFT/Net

Banking/RTGS etc.) before the admission date of NIT Durgapur (JULY 19-23, 2018). During admission

to the institute hostel, the identity of the student [For Indian students: Name of the students, father’s

name, JEE main (2018) Roll No., For foreign students through DASA/MEA etc.: Name of the

students, father’s name, Reference number] has to be clearly mentioned in the Proof of payment slip

(generated /download/hand written payment advice) failing which the payment slip will not be

accepted/entertained at the time of admission. This may lead to fresh payment of the mess charges.

The bank details for payment of mess charges under different categories of students are appended

below.

However the cash payment at institute branch of SBI is also permitted at the time of admission.

B.Tech/ Dual Degree 1st year (Girl Students)- FOREIGN PASSPORT HOLDER

HOSTEL: PRITILATA HALL OF RESIDENCE (HALL- 8)

A/C NAME: HALL- 8

SBI, R E COLLEGE DURGAPUR BRANCH

ACCOUNT NO— 30562782563

IFS CODE –SBIN0002108.

B.Tech/ Dual Degree 1st year (Girl Students)- INDIAN

HOSTEL: SISTER NIVEDITA HALL OF RESIDENCE (HALL- 7)

A/C NAME: HALL- 7


ACCOUNT NO—35618059320

IFS CODE –SBIN0002108.

B.Tech/ Dual Degree 1st year (Boy Students)-FOREIGN PASSPORT HOLDER

HOSTEL: APJ ABDUL KALAM HALL OF RESIDENCE (HALL- 12)

MESS ACCOUNT: NOT REQUIRED

B.Tech/ Dual Degree 1st year (Boy Students)- INDIAN

HOSTEL: MEGHNAD SAHA HALL OF RESIDENCE (HALL- 11)

A/C NAME: HALL- 11


A/C no: 36961031938

IFS Code: SBIN0002108

HOW TO REACH NIT DURGAPUR:

LOCATION OF NIT DURGAPUR:

Durgapur is situated at a distance of about 180 KMs from Kolkata on

Howrah-Delhi rail route and also well connected by road on NH2.

It is at 1 km. away from Durgapur City Centre main bus stand and 8 km

from Durgapur Railway station. Rickshaw and Auto Rickshaw are the

common mode of transport. Taxis and App Cab are also available.

Nearest Airport: Kazi Nazrul Islam Airport (Located in Andal, Durgapur)

CERTIFICATE FORMATS:

A. OBC & PWD

1. OBC-NCL Certificate must be issued on or after 1st April 2018 (JoSAA Format)

2 Certificate for Persons With Disabilities (PwD) must be in JoSAA Format

B. INCOME CERTIFICATE:

1. Certificate must be issued on or after 1st April 2018.

2. Format as per the Competent Issuing Authority.

3. Original Income certificate has to be submitted on date of admission.

4. COMPETENT ISSUING AUTHORITY: As given in the next page.

5. Remission of Tuition fees will be allowed only on submission of suitable income certificate.

Page | 61

ANNEXURE 8

MEDICAL CERTIFICATE

(to be issued by a Registered Medical Practitioner)

GENERAL EXPECTATIONS

Candidates should have good general physique. In particular,

1. Chest measurement should not be less than 70 cm, with satisfactory limits of expansion and contraction.

2. Vision should be normal. In case of defective vision, it should be corrected to 6/9 in both eyes or 6/6 in

the better eye. Colour blind and uniocular (having vision in only one eye) persons are restricted from

admission to certain courses.

3. Hearing should be normal. Defective hearing should be corrected.

4. Heart and lungs should not have any abnormality and there should be no history of mental illness and

epileptic fits.

1 Name of the candidate:

2 Identification Mark (a mole, scar or birthmark), if any

3 Major illness/operation, if any (specify nature of illness/operation)

4 Height in cm: Weight in kg: Blood Group:

5 Past History (a) Mental illness

(b) Epileptic Fit

6 Chest (a) Inspiration in cm (b) Expiration in cm

7 Hearing

8 Vision with or

without glasses:

Right Eye Left Eye Colour Blindness Uniocular vision (having vision in only one eye)

9 Respiratory System

10 Nervous System

11 Heart (a) Sounds (b) Murmur

12 Abdomen

(a) Liver

(b) Spleen

Hernia Hydrocele

13 Any other defects:

Certificate of Medical Fitness

The candidate fulfils the prescribed standard physical fitness, medical fitness and is FIT

for admission to Engineering/Architecture/ Pharmaceutics/ Science Course

The candidate does not fulfil the prescribed standard of physical fitness/medical fitness

and is unfit/temporarily unfit for admission due to following defects:

_______________ ________________ __________________ _________________

Name of the Doctor Signature Registration number Seal

OBC-NCL Certificate Format

(To be issued on or after 01.04.2018)

FORM-OBC-NCL

FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD

CLASSES (NCL) APPLYING FOR ADMISSION TO CENTRAL EDUCATIONAL

INSTITUTIONS (CEIs), UNDER THE GOVERNMENT OF INDIA

This is to certify that Shri/Smt./Kum* _____________________________________ Son/

Daughter* of Shri/Smt.* ______________________________________of Village/

Town* District/Division* in the

State/Union Territory belongs to the

__________________________________ community that is recognized as a backward class under

Government of India**, Ministry of Social Justice and Empowerment’s Resolution No.

__________________________________ dated ___________________***

Shri/Smt./Kum. and/or

his/her family ordinarily reside(s) in the District/Division of

the State/Union Territory. This is also to certify that he/she

does NOT belong to the persons/sections (Creamy Layer) mentioned in Column 3 of the Schedule to

the Government of India, Department of Personnel & Training O.M. No. 36012/22/93- Estt. (SCT)

dated 08/09/93 which is modified vide OM No. 36033/3/2004 Estt.(Res.) dated

09/03/2004, further modified vide OM No. 36033/3/2004-Estt. (Res.) dated 14/10/2008, again

further modified vide OM No.36036/2/2013-Estt (Res) dtd. 30/05/2014.

Dated:

District Magistrate /

Deputy Commissioner / Any other Competent Authority

Seal

* Please delete the word(s) which are not applicable. ** As listed in the Annexure (for FORM-OBC-NCL) *** The authority issuing the certificate needs to mention the details of Resolution of

Government of India, in which the caste of the candidate is mentioned as OBC. NOTE:

(a) The term ‘Ordinarily resides’ used here will have the same meaning as in Section 20 of the

Representation of the People Act, 1950.

(b) The authorities competent to issue Caste Certificates are indicated below:

(i) District Magistrate/ Additional Magistrate/ Collector/ Deputy Commissioner/ Additional Deputy

Commissioner/ Deputy Collector/ Ist Class Stipendiary Magistrate/ Sub-Divisional magistrate/

Taluka Magistrate/ Executive Magistrate/ Extra Assistant Commissioner (not below the rank of

Ist Class Stipendiary Magistrate).

(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.

(iii) Revenue Officer not below the rank of Tehsildar’ and

(iv) Sub-Divisional Officer of the area where the candidate and/or his family resides

ANNEXURE for FORM-OBC-NCL

Sl. No. Resolution No. Date of Notification

1 No.12011/68/93-BCC(C) 13.09.1993

2 No.12011/9/94-BCC 19.10.1994

3 No.12011/7/95-BCC 24.05.1995

4 No.12011/96/94-BCC 09.03.1996

5 No.12011/44/96-BCC 11.12.1996

6 No.12011/13/97-BCC 03.12.1997

7 No.12011/99/94-BCC 11.12.1997

8 No.12011/68/98-BCC 27.10.1999

9 No.12011/88/98-BCC 06.12.1999

10 No.12011/36/99-BCC 04.04.2000

11 No.12011/44/99-BCC 21.09.2000

12 No.12015/9/2000-BCC 06.09.2001

13 No.12011/1/2001-BCC 19.06.2003

14 No.12011/4/2002-BCC 13.01.2004

15 No.12011/9/2004-BCC 16.01.2006

16 No.12011/14/2004-BCC 12.03.2007

17 No.12011/16/2007-BCC 12.10.2007

18 No.12018/6/2005-BCC 30.07.2010

19 No. 12015/2/2007-BCC 18.08.2010

20 No.12015/15/2008-BCC 16.06.2011

21 No.12015/13/2010-BC-II 08.12.2011

22 No.12015/5/2011-BC-II 17.02.2014

SC/ST Certificate Format

FORM-SC/ST

FORM OF CERTIFICATE TO BE PRODUCED BY SCHEDULED CASTES (SC) AND SCHEDULED

TRIBES (ST) CANDIDATES

1. This is to certify that Shri/ Shirmati/ Kumari* _________________________________________________________ son/daughter*

of _____________________________________ o f Village/Town * ________________________________________

District/Division* _________________________________ of S tate/Union Territo ry* _____________________________ belongs to

th e Scheduled Caste / Sch eduled T rib e* und er :-

* T he Constitu tio n (Scheduled Castes) Order, 1950

* T he Constitu tio n (Scheduled T rib es) Order, 1950

* T he Cons titution (Scheduled Cas tes) (Union Territories) Order, 1951

* T he Constitu tio n (Scheduled T rib es) (Union Territories) Order, 1951

[As amended by th e Scheduled Castes and Scheduled Trib es L ists (Mod ific ation Ord er) 1956 , the Bombay Reo rgan isa tion Act, 1960, the Punjab Reorganisatio n Ac t, 1966 , the State of Himachal P radesh Act, 1970, the No rth Eastern A reas (R eorganisation) Ac t, 1971 , the Scheduled C astes an d Schedu led Tribes Orders (A mendment) Act, 1976 and the Schedu led Castes an d Scheduled Tribes Orders (Amendmen t) Ac t, 2002]

* T he Constitu tio n (J ammu and Kashmir) Scheduled Castes O rder, 1956;

* T he Constitu tio n (Andaman and Nicobar Island s) S ch eduled T rib es O rd er, 1959, as amended by th e Scheduled Castes a nd Schedu led Tribes Order (Amendmen t) Ac t, 1976 ;

* T he Cons titution (Dadara and Naga r Have li) Schedu led Castes Order, 1962;

* T he Constitu tio n (D ad ara and Nagar Have li) Scheduled Trib es Ord er, 1962;

* T he Constitu tio n (Pondicherry) Scheduled Castes Order, 1964 ;

* T he Constitu tio n (U ttar Prad esh) Scheduled Tribes Order, 1967;

* T he Constitu tio n (Goa, Daman and Diu) Sch eduled C astes Order, 1968 ;

* T he Constitu tio n (Goa, Daman and Diu) Sch eduled T rib es O rder, 1968;

* T he Constitu tio n (Nag aland) Sch eduled Trib es Ord er, 1970;

* T he Constitu tio n (S ikk im ) Scheduled Castes Ord er, 1978;

* T he Constitu tio n (S ikk im ) Scheduled Tribes Order, 1978;

* T he Constitu tio n (J ammu and Kashmir) Scheduled Tribes Order, 1989;

* T he Constitu tio n (Scheduled Castes) Order (Amendm ent) Act, 1990;

* T he Constitu tio n (Scheduled T rib es) Order (Amendmen t) Act, 1991 ;

* T he Constitu tio n (Scheduled T rib es) Order (Second Amendment) Act, 1991.

2. # This certific ate is issued on the basis of th e S cheduled Castes / Sch eduled T rib es* Certific ate issu ed to Shri /Sh rim ati*

fath er/mother* o f Sh ri /Shrim ati /Kum ari* ___________________________ of Villag e/Town*

in District/Divisio n* _____________________________ o f the S tate State/Un ion

T erritory*________________________________ who belong to the Caste / Tribe* wh ich is rec ognised as a Scheduled Caste / S ch eduled

T rib e* in th e State / Un ion Territory* ____________________ issued by th e ____________________ d ated ________________.

3. Sh ri/ Shrimati/ Kumari * and / or* his / her* family o rdinarily resid e(s)** in Villag e/Town*

o f D istrict/Division* of th e State Union Territo ry* o f .

Place:

State/Un ion Territory*

Signature:

Designation

(with seal of th e Offic e)

Date:

* Please delete the word(s) which are not applicable. # Applicable in the case of SC/ST Persons who have migrated from another State/UT. IMPORTANT NOTES

The term “ordinarily reside(s)**” used here will have the same meaning as in Section 20 of the Representation of the People Act, 1950. Officers

competent to issue Caste/Tribe certificates:

1. District Magistrate / Additional District Magistrate / Collector / Deputy Commissioner / Additional Deputy Commissioner / Deputy Collector / Ist Class

Stipendiary Magistrate / City Magistrate / Sub-Divisional Magistrate / Taluka Magistrate / E xecutive Magistrate / E xtra Assistant Commissioner.

2. Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.

3. Revenue Officers not below the rank of Tehsildar.

4. Sub-divisional Officer of the area where the candidate and/ or his family normally reside(s).

5. Administrator / Secretary to Administrator / Development Officer (Lakshdweep Island).

6. Certificate issued by any other authority will be rejected

Form-II

Disability Certificate

FORM-PwD (II)

(In cases of amputation or complete permanent paralysis of limbs and in cases of blindness)

(NAME AND ADDRESS OF THE MEDICAL AUTHORITY ISSUING THE CERTIFICATE)

(See rule 4)

Certificate No. Date:

This is to certify that I have carefully examined Shri/Smt./Kum.

son/wife/daughter of Shri Date of

Birth (DD/MM/YY) Age years, male/female

Registration No. permanent resident of House No.-

Ward/Village/ Street Post Office

District State

, whose photograph is affixed above, and am satisfied that:

1. he/she is a case of:

a. locomotor disability

b. blindness

(Please tick as applicable)

2. the diagnosis in his/her case is

3. He/ She has % (in figure) percent (in words)

permanent physical impairment/blindness in relation to his/her (part of body) as per

guidelines (to be specified).

4. The applicant has submitted the following document as proof of residence:-

Nature of Document Date of Issue Details of authority issuing certificate

(Signature and Seal of Authorised Signatory of notified Medical Authority)

Form-III Disability

Certificate

(In cases of multiple disabilities)

FORM-PwD(III)


(See rule 4)


This is to certify that I have carefully examined Shri/Smt./Kum. _

son/ wife/daughter of Shri

Date of Birth (DD/MM/YY) Age years,

male/female Registration No. permanent

resident of House No. _ Ward/Village/Street

Post Office District

State , whose

photograph is affixed above, and are satisfied that:

1. He/she is a Case of Multiple Disability. His/her extent of permanent physical impairment/ disability

has been evaluated as per guidelines (to be specified) for the disabilities ticked below, and shown

against the relevant disability in the table below:

S. No. Disability Affected

Part of Body

Diagnosis Permanent physical

impairment/mental

disability (in %)

1 Locomotor disability @

2 Low vision #

3 Blindness Both Eyes

4 Hearing impairment £

5 Mental retardation X

6 Mental-illness X

@ - e.g. Left/Right/both arms/legs

# - e.g. Single eye/both eyes

£ - e.g. Left/Right/both ears

2. In the light of the above, his/her overall permanent physical impairment as per guidelines (to be

specified), is as follows:

In figures: percent

In words: percent

3. The above condition is progressive/ non-progressive/ likely to improve/ not likely to improve.

4. Reassessment of disability is:

(i) not necessary

Or

(ii) is recommended/after years months, and therefore this certificate shall be

valid till (DD/MM/YY)

5. The applicant has submitted the following document as proof of residence:


6. Signature and seal of the Medical Authority:

Name and Seal of Member Name of Seal of Member Name and Seal of the Chairperson

Form-IV Disability

Certificate

(In cases other than those mentioned in Forms II and III)

FORM-PwD(IV)


(See rule 4)


This is to certify that I have carefully examined Shri/Smt./Kum. _

son/ wife/daughter of Shri

Date of Birth (DD/MM/YY) Age years,

male/female Registration No.

permanent resident of House No. _ Ward/Village/Street

Post Office District

State ,

whose photograph is affixed above, and am satisfied that he/she is a case of disability.

1. His/her extent of percentage of physical impairment/disability has been evaluated as per

guidelines (to be specified) and is shown against the relevant disability in the table below:

S. No. Disability Affected

Part of Body

Diagnosis Permanent physical

impairment/mental

disability (in %)

1 Locomotor disability @

2 Low vision #

3 Blindness Both Eyes

4 Hearing impairment £

5 Mental retardation X

6 Mental-illness X

(Please strike out the disabilities which are not applicable.)

@ - e.g. Left/Right/both arms/legs

# - e.g. Single eye/both eyes

£ - e.g. Left/Right/both ears

2. The above condition is progressive/ non-progressive/ likely to improve/ not likely to improve.

3. Reassessment of disability is:

a. not necessary

Or

b. is recommended/after years months, and therefore this certificate shall

be valid till (DD/MM/YY)

4. The applicant has submitted the following document as proof of residence:


(Authorised Signatory of notified Medical Authority)

(Name and Seal)

Countersigned

{Countersignature and seal of the CMO/Medical Superintendent/Head of Government Hospital, in

case the certificate is issued by a medical authority who is not a government servant (with seal)}

Note: In case this certificate is issued by a medical authority who is not a government servant, it shall

be valid only if countersigned by the Chief Medical Officer of the District. Note: The principal rules were

published in the Gazette of India vide notification number S.O. 908(E), dated the 31st December, 1996

FORM-DYSLEXIC-1

FORMAT OF MEDICAL CERTIFICATE / REPORT TO BE PRODUCED BY DYSLEXIC CANDIDATE

{To be obtained from any Dyslexia Association*}

Date:

PSYCHO-EDUCATION EVALUATION REPORT

Name of the candidate:

Photograph

Date of Birth: of the

Candidate

Registration in the Dyslexia Assn. (date / number):

Name of the Father/Mother/Guardian:

Name/address and Regn. No.

of the Dyslexia Association :

Physical & Neurologic Assessment: [ ]

Psychological Assessment: [ ]

WISC Verbal IQ:

Performance IQ:

Full Scale IQ:

Interpretation:

[ ]

Educational Assessment: [ ]

Certified that:

1. The condition of handicap is: MILD / MODERATE / SEVERE (tick whichever is applicable)**

2. The disability is PERMANENT in nature.

*Some Dyslexia Associations:

1. Dyslexia Trust of Kolkata, Divya Jalan, Aruna Bhaskar 3, Dover Park, Kolkata – 700019

2. Dyslexia Association Of Andhra Pradesh (DAAP), 3-4-494/1,1st Floor, Macherla Gastrology Hospital,

Reddy College Road, Barkatpura, Hyderabad, Telangana, 500027

3. Madras Dyslexia Association, 94 Park View, 1st Floor, G.N. Chetty Road, T. Nagar, Chennai – 600017

4. Maharashtra Dyslexia Association, 003, Amit Park Bldg, L J Road, Deonar, Mumbai 400088

5. The Dyslexia Association of India, MZ-47, The Centre Stage Mall, Plot No 01, Block L, Sector 18, NOIDA

201303

**Learning Disability is a permanent developmental disorder. Currently there are no standard

approved methods to quantify the disorder. However the method of diagnosis is based on significant

impairment in academ ic achievement. To avail the benefit of relaxed norm under PwD category, the

candidate must come under SEVERE category.

Name of the certifying official:

Seal:

FORM-DYSLEXIC-2

*CERTIFICATE TO BE PRODUCED BY DYSLEXIC CANDIDATE FROM THE

PRINCIPAL OF THE SCHOOL/COLLEGE LAST ATTENDED

Testimonial

Date:

Name of the candidate: Photograph

Date of Birth:

Name and Address of the School/College:

Certified that Shri/Shrimati/Kumari ________________________________

son/daughter of _____________________________________________ of

______________________ village/town passed his/her Class XII from this

school and as per records, availed concession under dyslexic category.

Signature with seal:

*A candidate passing Class XII or equivalent through open school system or in private mode

may submit the certificate to this effect from the competent authority in the board certifying

the concessions availed under dyslexia.