Annexure 3

Security Office
Sri Sri University, Bidyadharpur Arilo, Ward No 3, Cuttack, Odisha - 754006
STUDENTS VEHICLE GATE PASS PROFORMA UNDERTAKING
(To be filled in Duplicate)
I,
____________________________________________
son/daughter
of
___________________________________________
of Tehsil _________________________ Dist. _______________________
__________________________ do undertake:

Shri
State

1. That I am a bonafide student of class________________________ vide

Enrolment
No.
____________________________
of
the
Department
_________________________________________________ SSU, Cuttack.
2. That I have my valid driving license
________________________ (Attested copy enclosed).

vide

License

No.

3. That I have my own vehicle Car/Motor Cycle/Scooter/Scooty vide

Registration No. __________________________ registered in the name of myself/
father/ mother/ brother/ sister/ relative. (Attested copy of RC enclosed). In
case of RC is in the name OF Relative, furnish an affidavit in this regard.
4. That I have my valid identity card for session 2016-17 duly signed and
issued by the Head of the Department (Attested copy enclosed).
5. That I shall abide by all rules and regulations of the Indian Vehicle Act
applicable from time to time.
6. That my above vehicle will never be given to anyone for ridding purpose
inside the campus.
7. That my Vehicle will be parked in an earmarked space provided by the
University Security Office.
8. That my vehicle will not be misuse for any activity of indiscipline in the
campus of the university.

9. That I shall not ride my vehicle in more than 20 Kms. speed.

10. That I shall not carry more than one person in my two wheeler.
11. That I shall abide by all instructions relating to safety/ security/ discipline
issued by the University from time to time.

12. That in case I am found responsible for any violation of above

undertaking, I shall be liable for rustication from the university and shall also
be subject to any police / legal prosecution under law without any notice.
Signature of Candidate:
Name of the candidate in capital letter:
Contact No.: ____________________

VERIFIED
Signature of the Head
With Seal
Gate Pass / Sticker issued vide its Gate Pass / Sticker No. ______________ from
University Security Office and parking is allowed at the identified parking
place of the University.

SECURITY OFFICER