ANTI RAGGING Undertaking BY STUDENTS AND PARENTS/GUARDIANS
Mobile Number of Father or Mother or Guardian

Fields marked with red* are compulsory.
Personal Details
Student's Family Name *      
Student's Middle Name     
Student's First Name *       
Gender *     
Nationality *       
Student's Mobile Number*       
Student’s friends Mobile number in case of an emergency *         
Landline Number     
Student's email ID *         
Confirm student's email ID *         
Permanent Address 1 *      
Address 2
City *      
State *       
Parent/Guardian Details
Parent/Guardian’s name*              
Parent/Guardian Address 1*       
Address 2
City *      
State *       
Residence Phone No *         
Mobile No of Parent/Guardian*      
Mobile at home 1 *     
Mobile at home 2
Parent/Guardian’s Email ID *              
College Details
State in which the College is *       
Is it a Professional College or a General College *      
Name of the College *       
Name of Affiliated University *      
It is Deemed University *     
Head of the College /Director/Principal
Director/Principal Family Name*      
Director/Principal First Name *         
Middle Name *     
Director/principal Gender *     
College Phone Number STD CODE *     
College Phone No. 1*         
College Phone No. 2
What is the name of the nearest Police station to your College?
Nearest Police station Name and Address*       
Course Details
Under Graduate or Post Graduate  *       
Name of the Course *       
Your Registration/Enrolment  Number
How many students are in your Class *       
Year of Study*      
Please enter the string shown in the image*

Fields marked with red * are compulsory.
National Anti Ragging Help Line (UGC Crisis Hotline)
24x7 Toll Free Number* 1800-180-5522
(helpline@antiragging.in)
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