83 | Mahant Darshan Das Mahila College, Muzaffarpur

EDIT Form

Application form for Hostel

Stream / Faculty: Commerce

Application Form No. 101580

Date of Submission 05 April, 2021

Personal Details

Name of Student 83

Father/Husband name Analise

Mother name Leighton

Date of Birth 18-08-1993

Gender Female

Reservation Category ST

Mobile No. 6602466773

Marital Status Married

Physically Challenged(PH) No

Type of Disability 15

Aadhar Number 28

Email id eritreanstungrcm@stuffedgrow.site

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Course Details

Name of course IMB

Stream / Faculty Commerce

Class Roll Number 67

Session 2020-2023

Guardian Details

Father Photo

Mother Photo

Family Member Photo

Local Guardian Photo

Name of Family Member Netty

Relation with Student 25

Name of Local Guardian Hetty

Relation with Student 28

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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? 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) Analise 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 |