Letter Of Undertaking-Authorisation Form-Symbiosis International University Page 4
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48. I also understand that in case of a medical problem, certain medical procedures may
need to be performed by hospitals to treat the Medical conditions. In such cases, as
decided by the doctor, consent is required to perform the required medical
procedures. Any delay in producing the consent may prove to be fatal and under any
circumstance, medical treatment should not be delayed for want of consent from my
parents/ guardian.
9. I therefore, in my interest, authorize the Symbiosis International University and /or
the Institution and/or any person designated by the University /Institution, to give
consent for me and on behalf to perform the medical procedures. I shall stand by
this authorization and shall not hold Symbiosis International University and /or the
Institution and/or any person designated by the University / Institution responsible /
liable for giving consent.
10. Symbiosis has insured each student to meet medical expenses up-to Rs. 50,000/-in
case of non accidental emergencies (as per the Mediclaim Insurance Policy) &
Rs.1,00,000/- in case of Rail/Road Traffic accidents. But it may happen that in some
cases (exclusion clauses), the insurance policy may not be honored. Hence the
University/Institution may have to incur certain expenses. I and/or my parents
undertake to pay the total amount within 15 days of demand by the University /
Institute.
11. I have signed this Undertaking and authorized Symbiosis International University and
/or the Institution and/or any person designated by University /Institution to give
consent for medial procedure on my free will and without any influence / pressure
from any person.
Hence this Undertaking and Authorization.
Place: Pune
Date:
________________________
Signature of the Student
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