SELF ATTESTED APPLICATION FOR OPTING OUT OF NOVEMBER2020

EXAMINATION AND APPEARING IN JAN2021/FEB2021

EXAMINATION / MAY2021 EXAMINATION

I son / daughter of born

on / / Registration Number Roll No.
wish to affirm and undertake as under:

1. I have made application for appearance in the November2020 examination during 05-08-2020 to
04-09-2020 / 09-09-2020 to 11-09-2020

2. I at my own free will have decided to Opt out of the November2020 examination and in lieu of
the same opting to appear in :

January2021/February 2021 exams - second tranche of November 2020 examination

OR
May2021 exams

due to following reasons:

a. I declare that I am COVID-19 positive or having symptoms of COVID-19

b. I declare that my family members with whom I am staying are COVID-19 positive

c. I declare that my residence is located in an area which is declared as Containment Zone by the
Central Government/State Government/Local Authorities

3. I understand that by making this application I am withdrawing my November2020 examination

application and will NOT appear in the November2020 examination / remaining papers of
November2020 examination

4. I request that unexpired exemption if any valid for the November2020 examination be carried
forward for my appearance in Jan2021/Feb2021 examination / May2021 examination

5. I hereby agree that in case I do not appear in the Jan2021/Feb2021 examination / May2021
examination I shall not claim any benefits like carry over of exemptions / fees refund etc. for the
same

Signature of the Candidate:

Signature of the Parent (in case the candidate/examinee is a Minor):

Date: Place: