PEC UNIVERSITY OF TECHNOLOGY CHANDIGARH

Application form for admission in various hostels

For the session 2016-17
Please Fill the Option:-

S.No. Year & Program Hostel Tick

1. 2nd year UG(Boys) students& Himalya
3rd year UG(Boys) students (non-circuit branches)
2. PG(Boys) students& Aravali
All Ph.D. students
3. 4th year UG(Boys) students & Kurukshetra
3rd year UG(Boys) students (circuit branches)
4. 2nd to 4th year UG(Girls) students Vindhya
nd
5. 2 year PG(Girls) & Ph.D. (Girls) students Kalpna Chawl;a

1. Name in full (block letters) :

2. Mobile number (self) :
3. Student ID number :
4. Branch and year :
5. Course of study (BE/ME) :
6. E-mail address :
7. Whether resident of Tricity : YES/NO
8. Fathers name & present :
Address (attach address
proof of parents) and

Phone Number :
(with STDCode)
Mobile Number :

9. Name, address & contact :

number of local guardian
10. Academic details
1. UG (2nd, 3rd, 4th year) andPG (2nd year) students
SGPA
SGPA
CGPA
a. Current CGPA as per the result of last semester [Session 2015-16 (1)](attach proof).
(For 3rd year students copy of DMC of 5th semester [2015-16 (1)])
2. All Ph.D. students
a. Status of students: Full Time
b. GATE qualified: Yes / No (attach proof)
 11. Details of previous academic sessions stay in other PEC hostels

Hostel Room Number Session 2015-16

Hostel Room Number Session 2014-15
Hostel Room Number Session 2013-14
12. For non-residents of Tricity, Undertaking is attached: Yes/No
(As per prescribed proforma Annexure-I)

FOR OFFICE USE ONLY

Details of money deposited:

Mode of payment: In the account of _______________ hostel/draft: Amount: __________
Draft Number & Drawn on ________________________________ Date: _____________

Hostel Attendant Accountant Chief Warden/Warden

 CERTIFICATE AND PLEDGE BY THE STUDENT/APPLICANT

a) I hereby certify that the entries made by me in this form are correct to the best of my knowledge and I
have no suppressed any information in any manner. I further understand that if at any stage it is found
that I have provided any wrong information or have suppressed any information to seek admission in the
hostel my admission in the hostel shall stand cancelled automatically.
b) I certify that I was not involved in any offence, illegal activities, expelled from any hostel in previous
years and no case is pending against me in any court of law.
c) I will live in the hostel with a sense of owness and as a responsible member of the hostel.
d) I will use the hostel/mess/club property with utmost care.
e) I will not keep any guest in my room without the prior permission of hostel authority.
f) I will not leave the station/hostel without the prior permission to the hostel authority.
g) I do not owe any thing to any other mess/hostel of the PEC.
h) I will pay my mess/hostel dues regularly and well within the stipulated time period.
i) I will keep the room and furniture etc. intact throughout my stay in the hostel and will handover the same
in proper conditions to hostel authority. I will be responsible for any breakage and loss of the room and
its furniture.
j) I will observe proper decorum and discipline in the hostel mess and club.
I will not consume any intoxicants (liquor, cigarette drugs or any other similar things) in hostel
premises.
k) I will not install room cooler, air conditioner etc. in my room.
l) I will not use electric kettle, room heater, water immersion rod etc. in the room.
m) I will reside in the allotted room and will not make mutual interchange of the room with fellow hostlers.
n) I fully understand that the room is allotted either only for the current academic session or upto 30 th June
of the academic session whichever is early I will vacate the room accordingly in time.
o) I shall keep my room in lock and key whenever I go out of my room even for short duration in case any
theft occur in my room due to the above negligence I shall be responsible for the same.
p) I fully understand that for any violation or infringement of the above hostel and mess rules and any other
rules formulated and implemented time to time in the hostel. A disciplinary action and/or monetary fine
can be imposed on me by the authorities and/or student affair committed. Further my parents will be
called/informed about the misdeed done by me in the hostel.
q) I am fully aware that RAGGING IS A CRIME in the institute/hostel premises as per the judgment of
Honble Supreme Court if I am found guilty of indulging in ragging. I am liable to be punished and
expelled form the Hostel and institute and F.I.R. will be lodged/registered against me as per the
judgment of Honble Supreme Court.

Date:

Place: (Signature of applicant)

Note:-
1. Attach either the DRAFT OR ORIGINAL AND ONE PHOTOCOPY OF THE DEPOSIT SLIP (if
money is deposited in the PNB, Himalaya Hostel account) whatever may be the case, with this form.
2. Attach ONE MORE SELF ATTESTED PASSPORT SIZE PHOTOGRAPH of yours with this form.
3. Attach NO DUES SLIP if applicable from the previous Hostel Manager and Attendant with this form.
4. Only completed form alongwith all necessary attachments will be accepted.
5. It is mandatory to give the information of the vehicle owned by the hostel resident. Unauthorized
vehicles shall not be allowed to park in hostel.
All UG and PG students have to submit affidavit in the following format on a duly notorized on Rs. 10/- non judicial stamp paper)

AFFIDAVIT BY THE STUDENTS

I, _____________________________ S/o, D/o _______________________________________ resident of

____________________________________________________________________________________ have been
admitted to PEC University of Technology, Chandigarh in program _____________________ Year ___________
Branch ____________________ and has been allotted hostel accommodation at ___________________________
Hostel at PEC University of Technology, Chandigarh.

I am aware of the fact that, keeping of automated two/three/four wheelers in hostel premises is strictly prohibited, and
as per rules any student found keeping, using of driving automated vehicles of his own or of any other person inside
the campus of PEC University of Technology, Chandigarh shall be subject to appropriate disciplinary action including
permanent expulsion from hostel.

I promise to avoid by the rules of the hostel and hereby undertake that I shall abide by this rule and will not use any
automated vehicle in hostel premises.

I promise to avoid by the rules of the university and hereby undertake that I shall neither indulge myself nor instigate
any other student(s) in such activities or create or instigate or compel other to cause or create nuisance in the academic
atmosphere of the university. In case I am found involved in any act amounting to violation of discipline or
misconduct or act falling under the definitions. Breach of above undertaking disciplinary action be taken against me as
per university rules.

Declared this ____________________ (day) of ___________ month of _________________ (year)

(Signature of Candidate)

AFFIDAVIT BY PARENTS/GUARDIAN

I, __________________________ Father/Mother of __________________ students of PEC University of

Technology, Chandigarh, am aware of the law in regard to maintenance of hostel and university disciple and I agree
abide by the punishment awarded to my ward in case he/she found involve in act of breach of rules, misconduct,
indiscipline. This undertaking mentioned above by our ward would be binding by us till my ward complete his/her
study studies at PEC University of Technology, Chandigarh.

Signature of Mother Signatures of Father Signatures of Guardian

Date : __________________
Place : __________________
 UNDERTAKING

1. I hereby declare that I am not a resident of tricity i.e. Chandigarh, Panchkula, and Mohali.
2. My parents are also not having any permanent residence in the Tricity and are presently not residing the
Tricity.
3. Any information found false in this undertaking the Hostel/Room shall automatically be cancelled and I shall
never be eligible for the hostel accommodation in PEC University of Technology.

Name of the Student Signature of the Student

SID

Name of Programme

Year and Branch

Present Address

E-mail ID

Mobile Number(Self)

Mobile Number(Parents)

Land line number with code