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Hostel & Students Affairs Office,


 ,
Indian Institute of Management,

Indore.

 
GUEST ACCOMMODATION REQUEST FORM

1.

Mr./ / Ms. / __________________________________ /relationship__________________________________

2.

Mr./ / Ms. / __________________________________ /relationship__________________________________


from (/address) ___________________________________________________ ' * + | /is coming to visit me.

+ / ., 1  ' 4   5 6 8 * |
I, request you to kindly allot a guest room in my name for the period as stated below for his / her accommodation:
9 1
Date of arrival
 9 1
Date of departure
6
No. of days

:/ ()
am/pm (time)
:/ ()
am/pm (time)
 =>
Purpose of visit

?4 / A
Personal / Official

+ /  . I, hereby, undertake that:


1.
2.

+ . B D

E/F I I will pay accommodation charges in advance at the time of
booking.
= * A 'I hostel@iimidr.ac.in * 9 . 9  24 

4.

> | Refund in cases of cancellation needs to be informed 24 hours before date of booking of guest room in written or mail
at hostel@iimidr.ac.in.
+ L D
 O ? E/F | I will settle all the bills, service charges, and
mess charges of the guest.
 Q  Q S . D * , + ?4 E A

5.

' U / | My guest will scrupulously abide the institute rules. In case of any violations by my guest, I will be
personally liable for the consequences.
+ .   S  . =>Q ' . AQ * 6 E1

3.

= . | I am aware that this allotment can be cancelled by the hostel administration, if required
for any institute purposes or under any extraordinary circumstances.
Name:_______________________________ V . Roll No:_____________ Programme:________________
V. . Room No:______________________ ./ . Contact Phone_________________________________
5 Signature of Applicant:_______________________ 6 Date:_____________________________________

( For Office Use Only)


6 . Allotted room No. ____________ from ___________ to ___________ (6Q 9 . No. of Days)_______
D F. and amount of Rs. _____________@ __________  D Y | per recovered toward guest room chargers.
. . . L . PoS machine Inv. No._____________ 6 Dated___________. Sign. ( . . . HRC) _________

5 Signature ____________
(   Hostel & Student Affair)

6 Date: __________