UNIVERSITY OF MUMBAI
NATIONAL SERVICE SCHEME

Passport size
Photograph						 	National Service Scheme,
								Vidyapeeth Vidyarthi Bhavan,
								B- Road, 2ndfioor, Churchgate,
								Mumbai- 400 020.

UNDERTAKING OF THE PARTICIPATING STUDENT

I, Mr/Miss/Mrs.…………………………………………………………...………………………..Student of Padmabhushan Vasantdada Patil Pratishthan's College of Engineering, Sion, undertake to state that, I shall be attending the 7-day Residential Special Camp to be held at Village Tara (Bhandhanwadi), Tal – Panvel, Dist – Raigad from February 21,2014 to February 27,2014 being organised as per the requirement of the NSS Cell, University of Mumbai, at my own risk.

I further undertake to state that I shall be abiding by all the rules & regulations of the camp and NSS Cell, University of Mumbai, and shall be liable for strict disciplinary action for violation of the same.

Address:…………………………………………………………………………………………………………………………………………………………………………………………………
Mob. No……………………..
Date:- ………………
								Signature of the Student
RESPONSIBILITY CERTIFICATE
Certified that my Son/Daughter/Ward Mr/Ms.………………………………
is being allowed to participate in the 7-day Residential Special Camp to be held at Village Tara (Bhandhanwadi), Tal – Panvel, Dist – Raigad from February 21,2014 to February 27,2014 being organised as per the requirement of the NSS Cell, University of Mumbai.
If any accident occurs during this camp/programme, I or any of my relation of legal heir will not demand claim from University of Mumbai/College NSS unit, on account of my Son/Daughter/Ward is participating in this camp.

Signature of NSS Programme Officer				Signature of Parent/Guardian
Place:-……………….
Date:-……………….
								Signature of the Principal

Seal of the College