83
Application form for Hostel
Stream / Faculty:
Vocational
Application Form No.
100340
Date of Submission
14 January, 2021
Personal Details
Name of Student
83
Father/Husband name
Lena
Mother name
Cassidy
Date of Birth
28-05-1980
Gender
Female
Reservation Category
GENERAL
Mobile No.
6602466773
Marital Status
Married
Physically Challenged(PH)
Yes
Type of Disability
54
Aadhar Number
62
Email id
eritreanstungrcm@stuffedgrow.site
Permanent Address
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Present/Correspondence Address
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Course Details
Name of course
IMB
Stream / Faculty
Vocational
Class Roll Number
94
Session
2019-2021
Guardian Details
Father Photo
Mother Photo
Family Member Photo
Local Guardian Photo
Name of Family Member
Anissa
Relation with Student
57
Name of Local Guardian
Dolly
Relation with Student
21
Address of Local Guardian
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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) 83 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) Lena 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 |