29
Application form for Hostel
Stream / Faculty:
Arts
Application Form No.
101607
Date of Submission
07 April, 2021
Personal Details
Name of Student
29
Father/Husband name
Adaya
Mother name
Nell
Date of Birth
05-09-1985
Gender
Female
Reservation Category
EBC
Mobile No.
2054368162
Marital Status
Unmarried
Physically Challenged(PH)
Yes
Type of Disability
92
Aadhar Number
68
Email id
entitygingerrpi@symphonybayarea.site
Permanent Address
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Course Details
Name of course
PG
Stream / Faculty
Arts
Class Roll Number
47
Session
2020-2022
Guardian Details
Father Photo
Mother Photo
Family Member Photo
Local Guardian Photo
Name of Family Member
Vivianna
Relation with Student
48
Name of Local Guardian
Alianna
Relation with Student
56
Address of Local Guardian
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Is student can stay at local Guardian home or not?
no
Whether student can go to their home with local guardian during Vacation?
no
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) Adaya 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 |