83

Application form for Hostel

Stream / Faculty: Science
Application Form No. 100405
Date of Submission 17 January, 2021

Personal Details

Name of Student 83
Father/Husband name Delia
Mother name Floy
Date of Birth 29-01-2006
Gender Female
Reservation Category SC
Mobile No. 6602466773
Marital Status Married
Physically Challenged(PH) Yes
Type of Disability 26
Aadhar Number 94
Email id eritreanstungrcm@stuffedgrow.site
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Course Details

Name of course IMB
Stream / Faculty Science
Class Roll Number 30
Session 2019-2021

Guardian Details

Father Photo
Mother Photo
Family Member Photo
Local Guardian Photo
Name of Family Member Darleen
Relation with Student 33
Name of Local Guardian Erma
Relation with Student 94
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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) 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) Delia 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 |