29 | Mahant Darshan Das Mahila College, Muzaffarpur

EDIT Form

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 |