29

Application form for Hostel

Stream / Faculty: Science
Application Form No. 101575
Date of Submission 05 April, 2021

Personal Details

Name of Student 29
Father/Husband name Milly
Mother name Katina
Date of Birth 13-05-1984
Gender Female
Reservation Category BC
Mobile No. 2054368162
Marital Status Unmarried
Physically Challenged(PH) No
Type of Disability 33
Aadhar Number 26
Email id entitygingerrpi@symphonybayarea.site
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Course Details

Name of course intermediate
Stream / Faculty Science
Class Roll Number 81
Session 2020-2023

Guardian Details

Father Photo
Mother Photo
Family Member Photo
Local Guardian Photo
Name of Family Member Tamar
Relation with Student 56
Name of Local Guardian Eryn
Relation with Student 18
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Is student can stay at local Guardian home or not? yes
Whether student can go to their home with local guardian during Vacation? yes

Payment Details

Payment Status

UNPAID

नोट: बैंक स्टेटमेंट से मिलान के दरमयान UTR/Ref. Number गलत पाए जाने पर आवेदन प्रपत्र रद्द कर दिया जायेगा.

छात्रा के लिए घोषणा

मैं (नाम) 29 एतद घोषणा करती हूँ कि
1. इस आवेदन में दी गई सूचनाएँ मेरी जानकारी में सत्य है |
2. छात्रावास में निवास करने पर संयमित तथा मर्यादित आचरण करने की प्रतिज्ञा करती हूँ |
3. छात्रावास के अनुशासनिक नियमों, निर्देशों तथा अन्य अपेक्षित तथ्यों से सहमत हूँ. उसके अनुपालन में मुझसे किसी प्रकार की त्रुटि होगी तो मैं दंड की भगिनी बनूँगी |

माता/पिता के लिए घोषणा

मैं (माता/पिता का नाम) Milly एतद घोषणा करता/करती हूँ कि,
1. अपनी प्रतिपाल्या द्वारा छात्रावास के नियमों के अनुपालन तथा उसके द्वारा किये जाने वाले व्यवहारों के लिए उतरदायी रहूँगा/रहूँगी तथा उसके महाविद्यालय में होने वाले खर्च का वहन करूँगा/करुँगी |
2. जबतक मेरी प्रतिपाल्या को महविद्यालय छात्रावास में स्थान प्राप्त नहीं होता है तब तक के लिए उसके आवास की व्यवस्था में अन्यत्र करूँगा/करुँगी. मेरा स्थायी निवास इस शहर में नहीं है |