GURUKRUPA BOYS HOSTEL, NASHIK 422003
******
[Link]. ____________
ADMISSIONS FORM FOR HOSTEL ACCOMMODATION
1. Name of the Student (IN BLOCK LETTERS) : _______________________________________________
2. Father’s Name : __________________________________
3. Date of Birth : ___________________________ Passport size
photograph
4. Course Admitted :
5. Year in which studying ___________________________
6. Address of PARENT (in block letters) : ________________________________________________
who will be responsible for remitting
your Hostel fees and Address to which ________________________________________________
communication are to be sent
with pincode (must) _________________________________________________
_________________________________________________
Phone with STD Code / Mobile No & E-mail ID of Parent : _____________________________________
Hosteller : ________________________
7. Name of the Local Guardian : ______________________________________________
Address : ______________________________________________
______________________________________________
______________________________________________
Phone / Mobile No of L.G. : ______________________________________________
DECLARATION BY THE STUDENT
We agree to pay the hostel mess advance charges which is to be adjusted for future mess bills
on receipt from the contractor and also the rentals and establishment charges etc. shall be paid at the
time of admission to the hostel.
We have gone through all the provisions contained in the rules and regulations thoroughly
and will abide these rules and regulations.
stay is found unsatisfactory, due to my negligence, misbehaviour & indiscipline, I agree that I will
abide by your decision. I will immediately vacate the hostel if ordered to do so.
Date: _______________ ______________________________
(SIGNATURE OF THE STUDENT)
Place: _______________
______________________________
(SIGNATURE OF THE PARENT)
UNDER TAKING BY THE STUDENT
I, ______________________________________________________ am aware of the rules &
regulations of the hostel, hereby assure you in writing that I will not indulge or
take part in any activities that is detrimental to the smooth functioning of the
hostel. I will fully obey the orders of the Warden / Deputy Warden and strictly
follow hostel rules and regulations. I promise not to indulge in any form of
ragging. In case I am found guilty I shall be prepared to leave the hostel
immediately.
Date: _______________ Signature of the student ____________________
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
DECLARATION BY THE LOCAL GUARDIAN
I undertake full responsibility for any misbehavior and act of indiscipline of my
ward for which I have no objection to remove him from the hostel without my
notice.
Date: _____________ Sign of Local Guardian
