FORM GEN EWS
FORM OBC NCL
FORM OF CERTIFICATE TO BE PRODUCED BY SCHEDULED CASTES (SC) AND SCHEDULED
TRIBES (ST) CANDIDATES
Declaration by the Candidate for Conversion from OBC-NCL / GEN-EWS to GEN Category
Name of the candidate: ___________________________
Address: ___________________________
___________________________ ___________________________
JEE (Main) Application No.:
Mobile No: _________________________ Email: ________________________
I understand that as per the guideline from the Ministry of Personnel, Public Grievances and Pensions,
Govt. of India, I am required to submit OBC-NCL/GEN-EWS (check one) certificate issued on or after
April 1, 2021, to avail the benefit of the said category. Since I have not been able to collect the requisite
certificate, I would like to be converted to a GEN category candidate. I understand that once converted, I
will be not be able to avail the benefits of the said category, and this conversion will be final for the
purpose of any remaining activities of JoSAA-2021.
I understand that by submitting this form, if originally a seat is allocated to me in OBC-NCL/GEN-EWS
category, the seat will be cancelled and I will be considered for a fresh allocation of seat based on GEN
category in the next round of allocation (if any).
Signature of Father/Mother Signature of the Applicant
Name: Name:
Date: Date:
ANNEXURE 7
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 (a) Name of the candidate: (b) Gender:
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 Right Eye Left Eye Colour Blindness Uniocular vision(having
vision in only one eye)
without glasses:
9 Respiratory System
10 Nervous System
11 Heart (a)Sounds (b) Murmur
12 Abdomen Hernia Hydrocele
(a) Liver
(b) Spleen
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
Page | 61
Annexure 9
JoSAA 2021
Form for Withdrawal of Allotted Seat from JoSAA Counselling
(To be uploaded on JoSAA 2021 portal by the candidate while applying for withdrawal)
number ___________ _____________ have been allotted a seat
___________________________ (Branch Name) in the Institute _______________
______________________ through JoSAA
_________________________.
I would like to withdraw my allotted seat (by not accepting the same) and I do not want to
be considered for seat allocation/allotment in all the subsequent rounds (if any) of JoSAA
2021 due to the following reason:
_________________________________________________________________
_________________________________________________________________
I understand that any seat allocated to me shall stand cancelled and rejected; I will be out
of the JoSAA 2021 process and I will not be considered in any further rounds of JoSAA 2021
seat allocation process. Thus I will forfeit the eligibility for admission to any of the institutes
through JoSAA 2021.
(Signature of applicant) (Signature of parent/guardian)
Name: Name:
Date & Place: Relationship:
77
