83

Application form for Hostel

Stream / Faculty: Arts
Application Form No. 101079
Date of Submission 23 February, 2021

Personal Details

Name of Student 83
Father/Husband name Dorris
Mother name Taliyah
Date of Birth 24-08-1983
Gender Female
Reservation Category SC
Mobile No. 6602466773
Marital Status Married
Physically Challenged(PH) No
Type of Disability 57
Aadhar Number 65
Email id eritreanstungrcm@stuffedgrow.site
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Course Details

Name of course intermediate
Stream / Faculty Arts
Class Roll Number 62
Session 2019-2021

Guardian Details

Father Photo
Mother Photo
Family Member Photo
Local Guardian Photo
Name of Family Member Maggie
Relation with Student 20
Name of Local Guardian Jazzlyn
Relation with Student 41
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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? 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) Dorris 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 |