ARYAN BOYS HOSTEL 8th MILE STONE , G.T. ROAD DHUAI (GZB) 201206 .

1. Name ………………………………………………………
2. Fathers Name ………………………………………………………
3. Permanent Address ………………………………………………………
………………………………………………………
4. Present Address ………………………………………………………
………………………………………………………
5. Date Of Birth ………………………………………………………
6. College Name ………………………………………………………
7. Course Name ………………………………………………………
8. Roll No ………………………………………………………

(copy of address proof and college ID card should be Attached )

I hereby declare that the forgoing information is correct to the best of my knowledge and belif. I
understand that if any information furnised is found to be false or there has been supperession of any
Factual of material information in the application formj I shall be liable for action as deemed
necessary.

I read and understandthe rules and regulations and agree with them . I have also paid the registration
charges as per applicable, All fees are non refundable.

REGISTRATION FEE DETAILS

Reg. date…………………….Name……………………………………………………………………...
Secuity amount…………………………………………………………………………………………...
……………………………………………………………………………………………………………

Date………………
place……….. …… signature