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DR. BH IM RAO AMBEDKAR UN IVERSITY AGRADepartrhent of Physica I Ed ucation
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DR. BH tM RAO AMBEDKAR U N IVERSITY' AGRA
Deparlrhent of Physical Ed ucatton&SPorts
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DR. BH I M RAO AM BEDKAR U N IVERSITY, AG RADepaftrhent of Physical Education
&Sports
Letter
Date
Seal
Paste your
attested,
recent photo
Name of College
Date
Name of Box6r
Date of Birth
I hereby declare, that when entering boxing in Inter collegiate Boxing
(Women) Championship 2016-17 organized by D r. B.R. Ambedkar University, Agra
from l7-L0-I6 to 18-10-16, I am not pregnant, and I have had a pregnancy test done
within 14 days and that result of the test shoiled NO PREGNANCY.
Signed in the presence of :
Boxer's Signature Signature of Asstt. P roff./Secretary
Name
Designation
Seal
Inter Collegiate Boxing $D Championship
20t6-17
TINDERTAKING
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