NATIONAL INSTITUTE OF TECHNOLOGY

TIRUCHIRAPPALLI - 15
OFFICE OF THE ACADEMIC

Information for Provisional Admission into MCA Programme

under NIMCET 2023
The candidates who got seat allotment through NIMCET 2023 (in all Rounds) for provisional
admission into MCA programme at National Institute of Technology, Tiruchirappalli for the
academic year 2023-24 are requested to follow the guidelines as given below. Candidates are
advised to report for admission along with their parent(s)/guardian.

1. Candidate Registration and Reporting Schedule for Admission

All the candidates must Register and Enter their personal data well before the
admission dates using the following link (use only Mozilla Firefox browser):
https://misreg.nitt.edu/STUDENTREG/
The link will be active between 27.07.2023 (from 10.00 am onwards) to 30.07.2023 (up to 5.00 pm)
(i) Please follow the instructions as given in the above web link carefully and fill the
required details correctly.
(ii) Please make a note of the generated 8-digit Temporary Roll Number and keep a
copy for future reference.
(iii) Please send email to [email protected], if you face any issues during the registration process in
the NITT student portal.

Physical Reporting Schedule at NIT, Tiruchirappalli:

Date (s) 31.07.2023 & 01.08.2023

Time 10:00 am onwards
Venue First Floor, Third-i building, CSG, NIT-Tiruchirappalli

2. Scanned copy of original Certificates/Documents to be uploaded by the

candidate in the portal:
i. Provisional Admission Letter received from NIMCET 2023
ii. NIMCET 2023 Rank Card / Score Card
iii. Computer generated institute fee paid receipt
iv. Original Photo Id proof as per Govt. of India norms
v. Original Class X Mark sheet/ X Certificate and original Birth certificate (in
English/Hindi) in a single PDF, as a proof of DoB. (Birth certificate is optional)
vi. Original Class XII Mark sheet/ XII Certificate
vii. Original Statement of Grades/Marks obtained in the qualifying Examination in a
single PDF. (preferably Consolidated Grade/Mark Sheet with all subjects mentioned
in it)
 viii. Original Degree / Provisional Certificate
ix. Original Course Completion Certificate for result awaiting candidates
x. Original Transfer Certificate issued from the institute last studied/attended
xi. Original Migration Certificate, for other than Tamil Nadu candidates
xii. Original Certificate of Category (EWS / OBC-NCL / SC / ST), if applicable, issued
by the competent authority as per the prescribed format given in Annexure-I
(EWS/OBC-NCL category certificate must be issued on or after 01.04.2023).
Original Caste Validity certificate for Maharashtra State Candidates, if not available,
upload an undertaking as per format given in Annexure-I
xiii. OBC-NCL undertaking form for OBC candidates as given in Annexure-I (filled and
signed by the candidate)
xiv. Original Certificate for Persons with Disabilities (PWD) issued by Medical Board
notified under PWD Act (format given in Annexure-I)
xv. Late submission undertaking form (format given in Annexure-II), if necessary
xvi. Certificate of physical fitness obtained from a medical officer as per the prescribed
format given in Annexure-I

All the Original Certificates listed above to be produced by the

candidate at the time of physical reporting for Admission. Also, one
set of self-attested copy of all the certificates listed above to be
produced during physical reporting for Admission.

After successful completion of documents/ certificates verification during

physical reporting, Admission Letter will be issued by Academic Office, NIT,
Tiruchirappalli.

Note:
• In case, if the candidate is not able to get the certificate listed above
in Sl. No. (viii), (ix), (x) and (xi) at the time of admission due to
result awaiting/late issuance of certificate etc., he/she has to upload
the Late Submission undertaking form as per the prescribed
format given in Annexure-II
• If any certificate is in languages other than Hindi or English, true copy of the
same in English version is to be uploaded.

• Bring 4 Nos of recent colour photographs (2 Passport size and 2 stamp size)

• Candidates are advised to keep SCANNED COPY of all their original

certificates and sufficient number of attested photo-copies of all the certificates
for their future use, since all the Original Certificates submitted to National
 Institute of Technology, Tiruchirappalli will be retained by the Institute till the
whole admission process gets completed as per institute norms or till the
withdrawal of admission by the candidate in-between.

• For EWS/OBC-NCL candidates:

o Case I: Those candidates who are not able to obtain the EWS/OBC-NCL
certificate dated on or after 01.04.2023, they should upload the EWS/OBC-
NCL certificate obtained on or after 01.04.2022 along with an affidavit in
Rs.100/- stamp paper as per the format in Annexure-I.
Those candidates ie., under case I, must upload the Original Certificate of
Category (EWS / OBC & OBC-NCL) issued by the competent authority as
per the prescribed format given in Annexure-I issued on or after
01.04.2023 and Original Caste Validity certificate for Maharashtra State,
on or before 30th August 2023.
If they fail to produce on or before 30th August 2023, their admission shall
stand cancelled automatically. For such candidate’s refund will be made
as per the institute norms.

a. Those candidates who have appeared for final semester/year examination, provisional
admission is permitted provided their final marks are made available on or before 30th
September 2023. For such candidates, the examinations should be completed by 15th
August 2023.
b. Any candidate admitted provisionally shall produce the provisional/degree certificate
and all mark lists in original on or before 30th September 2023. Else, their admission
shall stand cancelled automatically. For such candidates refund will be made as per
the institute norms.
3. Fee to be paid at the time of Admission
a. Institute Fees
Fee Details:

• OC/EWS/OBC/OC-PwD/EWS-PwD/OBC-PwD candidates should pay

Rs. 50,450/- (90,450 – 40,000*) towards institute fees.

• For SC/ST candidates, the institute fees is Rs. 25,450/- (55,450 – 30,000*)

* Fee paid to NIMCET 2023

Payment by DD / Cash / Cheque / Pay Orders, etc are NOT ACCEPTED

Pay the fees online by following SBI i-Collect link:

“ https://www.onlinesbi.sbi/sbicollect/icollecthome.htm”

and under “NIT TRICHY INSTITUTION FEES” by choosing the payment category as follows:

“MCA ADMISSION FEE 2023”

The candidates should enter their Temporary Roll Number and NIMCET 2023 Registration
Number correctly during online payment.

After successful completion of the fee payment, kindly take a printout of the computer
generated payment receipt which should be produced at the time of admission. Further, the
candidates should enter the institute fee payment details in the registration link
(http://misreg.nitt.edu/STUDENTREG).

For institute fee details, refer the following link:

https://www.nitt.edu/home/academics/fee_details/pg_fee_structure/MCA-Institute-fee-
structure-for-2023-24-admission.pdf

b. Hostel Fees and Hostel Admission Details

Those who seek hostel accommodation are informed to pay the hostel fee before taking hostel
admission through the following link:
“ https://www.onlinesbi.com/sbicollect/icollecthome.htm?corpID=633054”

For hostel fee details and other procedures, refer the following link:
https://www.nitt.edu/home/students/facilitiesnservices/hostelsnmess/HOSTEL-FEES-
ODD-SEM-2023-24-MBA.pdf

The candidates must report to the hostel on 31.07.2023 or 01.08.2023 with

their Admission Letter issued by Academic Office of NIT, Tiruchirappalli.

Note 2:

Classes (Offline/ Physical mode) will start from 2th August, 2023.

Concerned authorities from the respective departments will be

intimating to the candidates regarding schedule and other necessary
details about classes

4. General Information
i. Hostel Facilities: Separate Hostel facilities are available for boys and girls.

ii. Banking facility: State Bank of India (SBI) branch is functioning in NIT,
Tiruchirappalli (NITT) Campus. (Bank Branch Code: 1617). ATM facilities are also
available.

iii. Location of the Institute: Tiruchirappalli is well connected by Air, Rail and Road
network. NITT is situated in a place called “THUVAKUDI” on the northern side of
 the Tiruchirappalli - Thanjavur road, 20 Kms away f r o m Tiruchirappalli junction.
Tiruchirappalli junction is one of the important Railway junctions of Southern
Railways.
iv. Reaching NITT Campus: All mofussil buses plying between Tiruchirappalli Central
Bus Stand and Thanjavur, stop at NITT Main Gate. (Tiruchirappalli Central Bus
Stand is about half a KM from Tiruchirappalli Railway Junction).

v. Town Bus No. 128 from Tiruchirappalli Central Bus Stand to Thuvakudi stops at NITT
Main Gate.

• A number of private Taxis, Call Taxis are available nearby

Tiruchirappalli Junction and Central Bus Stand. The approximate
Call Taxi fare from Tiruchirappalli Railway Station to NITT Main
Building will be about Rs.500/-
• If you are getting down at Chathiram Bus Stand/ Main-Guard Gate
(Commercial Centre of Tiruchirappalli), number of town buses ply
between Chathiram Bus Stand/ Main-Guard Gate and Thuvakudi.

5. Dress Code

All the boy students should come with formal dress to the class
rooms & computer labs, preferably full pant and shirt. Wearing
Boys : T-shirts and other informal dresses in the class rooms is strictly
prohibited.

All the girl students should come with formal dress to the class
Girls : rooms & computer labs, in Saree or C huridhar with Dupatta.
Wearing T-shirts and other informal dresses in the class rooms
& labs are strictly prohibited.

USE OF CELL PHONES / ELECTRONIC GADGETS IN

THE ACADEMIC PREMISES IS STRICTLY PROHIBITED
 6. Contact Address
Dr. G. Aghila
Director
Director National Institute of Technology,
Tiruchirappalli – 620 015.
Dr. Ramakalyan Ayyagari, Dean (Academic)
National Institute of Technology,
Dean (Academic) Tiruchirappalli – 620 015.
Phone No.: +91 431 2503013
Mobile No.: +91 9486001105
E-mail: [email protected]
Dr. G. Lakshminarayanan
Chairperson - PG Admissions
Chairperson-PG Admissions National Institute of Technology
Tiruchirappalli – 620 015.
Phone No.: +91 431 2504940
Mobile No.: +91 9486001157
E-mail: [email protected]
Dr.U.Srinivasulu Reddy, Hostel Convener
National Institute of Technology
Convener of Hostels Tiruchirappalli - 620 015.
Mobile No.: +91 9486001184
E-Mail : [email protected]

Associate Dean (PG) Chairperson Dean (Academic) Director

PG Admission Committee
 ANNEXURE – I
(Certificate of Physical Fitness)
and
(EWS/OBC/SC/ST/PWD Certificate Formats)
 CERTIFICATE OF PHYSICAL FITNESS
(To be issued by a Medical Officer)
I, Dr._______________________________ (IMC. Reg. No._____________________), do
hereby certify that I have examined Mr./Ms.
_______________________________________________ a candidate for admission to the
National Institute of Technology, Tiruchirappalli-15 and could not discover that he/she has
any disease, constitutional affliction or bodily infirmity.

His/Her age according to his/her own statement is _____________ years and by appearance
about _________ years.

Personal Marks of identification.

1. _____________________________________________________________________

2. _____________________________________________________________________

a. Weight ________________ b. Height _____________________

c. Chest measurement of full inspiration and expiration

d. Acuteness of vision* (in case where sight is corrected with glasses for each eye should be

noted)

e. Whether any abnormality of heart or lung?

f. Whether affected with hernia, hydeocele, vericocele, piles etc?

g. Hearing whether normal?

h. General health and build: whether good?

N.B: Any defects, deformities or other disabilities when present should be noted in detail.

Station: Signature:

Date: Name:
Seal:
(A Registered Medical Practitioner not below the rank of an Assistant Surgeon)
* Acuteness of vision: Left Eye
Right Eye
 INCOME & ASSEST CERTIFICATE TO BE PRODUCED BY
ECONOMICALLY WEAKER SECTIONS
Government of ………………………………..

(Name & Address of the authority issuing the certificate)

Certificate No. ______________________ Date: _______________

VALID FOR THE YEAR ___________

1. This is to certify that Shri/Smt./Kumari ________________________________ ,

son/daughter/wife of ____________________________ permanent resident of
_______________________, Village/Street _____________________ Post Office
__________________ District in the State/Union Territory _________________ Pin Code
___________ whose photograph is attested below belongs to Economically Weaker
Sections, since the gross annual income* of his/her family** is below Rs. 8 lakh (Rupees
Eight Lakh only) for the financial year 2022-2023. His/her family does not own or possess
any of the following assets***:
I. 5 acres of agricultural land and above;
II. Residential flat of 1000 sq. ft. and above;
III. Residential plot of 100 sq. yards and above in notified municipalities;
IV. Residential plot of 200 sq. yards and above in. areas other than the notified
municipalities.

2. Shri/Smt./Kumari ___________________________________ belongs to the

__________________caste which is not recognized as a Scheduled Caste, Scheduled Tribe
and Other Backward Classes (Central List).

Recent Passport size Signature with seal of Office ___________________

attested photograph of
the applicant Name _____________________________________

Designation ________________________________

Note:

* Income covered all sources i.e. salary, agriculture, business, profession, etc.
** The term 'Family" for this purpose includes the person, who seeks benefit of reservation,
his/her parents and siblings below the age of 18 years as also his/her spouse and children
below the age of 18 years.
*** The property held by a "Family' in different locations or different places/cities have been
clubbed while applying the land or property holding test to determine EWS status.
 FORM OF CERTIFICATE TO BE PRODUCED BY OTHER BACKWARD CLASSES APPLYING FOR
APPOINTMENT TO POSTS / ADMISSION TO CENTRAL EDUCATIONAL INSTITUTES (CEIs),
UNDER THE GOVERNMENT OF INDIA
“This certificate MUST have been issued on or after 1st April 2023”

This is to certify that Shri/Smt./Kum. _____________________________ Son/Daughter of Shri/Smt.

__________________________________ of Village/Town ________________________________ District/Division
__________________________ in the _________________________ State belongs to the ________________________
Community which is recognized as a backward class under:
(i) Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette of India Extraordinary Part I
Section I No. 186 dated 13/09/93.
(ii) Resolution No. 12011/9/94-BCC dated 19/10/94 published in the Gazette of India Extraordinary Part I Section I
No. 163 dated 20/10/94.
(iii) Resolution No. 12011/7/95-BCC dated 24/05/95 published in the Gazette of India Extraordinary Part I Section I
No. 88 dated 25/05/95.
(iv) Resolution No. 12011/96/94-BCC dated 9/03/96.
(v) Resolution No. 12011/44/96-BCC dated 6/12/96 published in the Gazette of India Extraordinary Part I Section I
No. 210 dated 11/12/96.
(vi) Resolution No. 12011/13/97-BCC dated 03/12/97.
(vii) Resolution No. 12011/99/94-BCC dated 11/12/97.
(viii) Resolution No. 12011/68/98-BCC dated 27/10/99.
(ix) Resolution No. 12011/88/98-BCC dated 6/12/99 published in the Gazette of India Extraordinary Part I Section I
No. 270 dated 06/12/99.
(x) Resolution No. 12011/36/99-BCC dated 04/04/2000 published in the Gazette of India Extraordinary Part I Section
I No. 71 dated 04/04/2000.
(xi) Resolution No. 12011/44/99-BCC dated 21/09/2000 published in the Gazette of India Extraordinary Part I
Section I No. 210 dated 21/09/2000.
(xii) Resolution No. 12016/9/2000-BCC dated 06/09/2001.
(xiii) Resolution No. 12011/1/2001-BCC dated 19/06/2003.
(xiv) Resolution No. 12011/4/2002-BCC dated 13/01/2004.
(xv) Resolution No. 12011/9/2004-BCC dated 16/01/2006 published in the Gazette of India Extraordinary Part I
Section I No. 210 dated 16/01/2006.
Shri/Smt./Kum. ________________________ and/or his family ordinarily reside(s) in the __________________________
District/Division of ________________________ State. 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.

Dated:

District Magistrate/
Deputy Commissioner, etc.
Seal
NOTE:
(a) The term ‘Ordinarily’ 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 / First 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.
OBC Certificate issued from Maharashtra State must be validated by social welfare Department of Maharashtra
Government
 OBC UNDERTAKING

Declaration/undertaking - for OBC Candidates only

I, ___________________________________ son / daughter of Shri

_________________________________ resident of ______________

village/town/city __________________________ district

________________________ State/UT hereby declare that I belong to the

____________________ community which is recognised as a backward class by the

Government of India for the purpose of reservation in services as per orders contained

in Department of Personnel and Training Office Memorandum No.36012/22/93- Estt.

(SCT), dated 8/9/1993. It is also declared that I do not belong to persons/sections

(Creamy Layer) mentioned in Column 3 of the Schedule to the above referred Office

Memorandum, dated 8/9/1993, which is modified vide Department of Personnel and

Training Office Memorandum No.36033/3/2004 Estt.(Res.) dated 9/3/2004. Also

declare that the condition of status/annual income for creamy layer of my

parents/guardian is within prescribed limits as on financial year ending on March 31,

2023.

Signature of the Candidate

Place: _________________
Date: _________________
 SC/ST Certificate Format

FORM OF CERTIFICATE TO BE PRODUCED BY A CANDIDATE BELONGING TO SCHEDULED CASTE OR SCHEDULED TRIBE

This is to certify that Shri/Smt./Kum._____________________________________________________________ Son/Daughter of Shri

________________ _______________________________of village/Town_______________________in District/ Division
_____________________________ of the State/Union Territory _____________________________ belongs to the __________________
caste/Tribe, which is recognized as a Schedule Caste/Scheduled Tribe under.
The Constitution (Scheduled Castes) order, 1950.
The Constitution (Scheduled Tribes) order, 1950.
The Constitution (Scheduled Castes)(Union Territory) order, 1951.
The Constitution (Scheduled Tribes) (Union Territory) order, 1951.
(As amended by the Scheduled Castes and Scheduled Tribes (Modification) Order 1956, the Bombay Reorganization Act, 1960, the
Punjab Reorganization Act, 1966, The State of Himachal Pradesh Act, 1970, the North Eastern Areas (Reorganization Act, 1971)
and the Scheduled Castes and Scheduled Tribes orders (Amendment) Act, 1976.)
*The constitution (Jammu & Kashmir) Scheduled Caste Order, 1956;
*The Constitution (Andaman and Nicobar Islands) Scheduled Tribes, 1959, as amended by the Scheduled Castes and Scheduled
Tribes orders (Amendment) Act. 1976;
*The Constitution (Dadra and Nagar Haveli) Scheduled Castes Order 1962;
*The Constitution (Dadra & Nagar Haveli) Scheduled Tribes Order, 1962;
*The Constitution (Pondichery) Scheduled Castes Order, 1964;
*The Constitution (Uttar Pradesh) Scheduled Tribes Order, 1967;
*The Constitution (Goa, Daman & Dieu) Scheduled Castes Order, 1968;
*The Constitution (Goa, Daman & Dieu) Scheduled Tribes Order, 1968;
*The Constitution (Nagaland) Scheduled Tribes Order, 1970;
*The Constitution (Sikkim) Scheduled Castes Order, 1978;
*The Constitution (Sikkim) Scheduled Tribes Order, 1978;
*The Constitution (Scheduled Castes) Orders (Amendment) Act, 1990.
*The Constitution (Scheduled Tribes) Order, (Amendment) Ordinance, 1991.
*The Constitution (Scheduled Tribes) Order, (Second Amendment) Act, 1991.
*The Constitution (Scheduled Tribes) Ordinance, 1996

This certificate is issued on the basis of the Scheduled Castes/Scheduled Tribes Certificate issue to
Shri ____________________________________________Father of Shri _____________________________________ ______of
village/town__________________________________ in District/Division _________________________________ of the State/UT
_________________ _____________who belongs to the ___________________ caste/Tribe which is recognized as a SC/ST in the
State/Union Territory __________________________________ issued by the ____________________________________ (name of the
prescribed issuing authority) vide their No. ______________________________________________ dated _______________ or Shri
____________ _____________________________ and or his/her family ordinarily reside(s) in Village/Town
__________________________of ___________________ District/Division of the State/Union Territory of ____________________.

Place______________ Signature______________
Date_______________ Designation ____________
(With seal of Office)
NOTE: - The terms ordinarily reside(s) used here will have the same meaning as in Section 20 of the Representation of the People
Act, 1950.
SC Certificate issued from Maharashtra State must be validated by Social Welfare Department and ST Caste certificate
must be validated by Tribal Development Department of Maharashtra Government

LIST OF AUTHORITIES EMPOWERED TO ISSUE CASTE/TRIBE CERTIFICATE:

1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner /Additional Deputy Commissioner/Dy. Collector/ 1st Class
Stipendiary Magistrate/Sub Divisional Magistrate/Extra Assistant Commissioner/Taluka Magistrate/Executive Magistrate.

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

3. Revenue Officers not below the rank of Tahsildar.
4. Sub-Divisional Officers of the area where the candidate and/or his family normally resides.
 PWD Certificate Format

DISABILITY CERTIFICATE FORMAT - 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)

No. - __________________________ Date:__________

Signature/LTI/RTI of the Candidate

Passport size
photograph of
the Candidate

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

_______________________, son/wife/daughter of Shri ________________________ Date of
Birth ____/______/_______ [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 (Please tick as applicable):

a. locomotor disability
b. blindness
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 the
certificate

Official Seal:
[Authorised Signatory of notified Medical Authority]

Name: _____________________________________
 DISABILITY CERTIFICATE FORMAT - III
{In cases of multiple disabilities}

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

No. - __________________________ Date:__________

Signature/LTI/RTI of the Candidate

Passport size
photograph of
the Candidate

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

_______________________, son/wife/daughter of Shri
________________________ Date of Birth ____/______/_______ [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 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:
Permanent physical
Affected Part impairment/mental
S. No. Disability Diagnosis
of Body disability
(in %)
1. Locomotor disability @

2. Low vision #

3. Blindness Both Eyes

4. Hearing impairment £

5. Mental retardation X

6. Mental-illness X

Contd.
2. In the light of the above, his/her overall permanent physical impairment as per guidelines (to
be specified), is as follows:
In figures:____________ %
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)___________.
@ - e.g. Left/Right/both arms/legs
# - e.g. Single eye/both eyes
£ - e.g. Left/Right/both ears

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

Nature of Document Date of Issue Details of authority issuing the
certificate

6. Signature and seal of the Medical Authority:

Name and Seal of Member Name and Seal of Member Name and Seal of the Chairperson
 DISABILITY CERTIFICATE FORMAT - IV
{In cases of any other case not covered in Format – II & III}

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

No. - __________________________ Date:__________

Signature/LTI/RTI of the Candidate

Passport size
photograph of
the Candidate

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

_______________________, son/wife/daughter of Shri
________________________ Date of Birth ____/______/_______ [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 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:
Permanent physical
Affected Part impairment/mental
S. No. Disability Diagnosis
of Body disability
(in %)
1. Locomotor disability @

2. Low vision #

3. Blindness Both Eyes

4. Hearing impairment £

5. Mental retardation X

6. Mental-illness X

Contd.
2. In the light of the above, his/her overall permanent physical impairment as per guidelines (to
be specified), is as follows:
In figures:____________ %
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)___________.
@ - e.g. Left/Right/both arms/legs
# - e.g. Single eye/both eyes
£ - e.g. Left/Right/both ears

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

Nature of Document Date of Issue Details of authority issuing the
certificate

Official Seal:
[Authorised Signatory of notified Medical Authority]

Name: _____________________________________

* 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.

Countersigned^

Official Seal:
[CMO/Medical Superintendent/Head of Govt. Hospital]

Name: _____________________________________

^Countersignature and seal of the CMO/Medical Superintendent/Head of Government Hospital is

essential in case the certificate is issued by a medical authority who is not a government servant.
 Annexure-II
NATIONAL INSTITUTE OF TECHNOLOGY, TIRUCHIRAPPALLI-15
OFFICE OF THE ACADEMIC
DECLARATION FOR THE LATE SUBMISSION OF RELEVANT DOCUMENTS
Candidate’s Details:

Name of the Candidate

Date of Birth
NIMCET Registration Number
NIMCET Score
Qualifying Degree Passing Status Appeared / Passed
Qualifying Degree
Qualifying Degree Discipline
Mobile Number
Email id

Allotment Details
Allotted Specialization Master of Computer Applications (MCA)
Allotted Category

The following certificates are not currently available with me due to late declaration of
result/non-issuance of certificate. I undertake that I will submit the following certificate(s) on
or before 30th September 2023, failing which I shall forgo my admission at NIT
Tiruchirappalli. I aware that all exams of my qualifying degree should have been completed
by 15th August 2023. Further, I aware that I will get the stipend only after submission of the
following certificates:
1. Original Provisional / Degree certificate
2. Original Transfer Certificate/Migration Certificate
3. Original Grade / Mark Sheets
4. Any other*

Date: Signature of the Candidate

Name & Signature of the verification official

*Note: This late submission form is not applicable for CATEGORY CERTIFICATE. EWS/OBC/SC/ST
candidates should produce the required original category certificate for verification.