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HOSTEL APPLICATION FORM 20 -20

Application No:

1. Name : ..
2. Gender : ..
3. Fathers /Husband /
4. Guardians Name : ..
5. Age, Date of Birth : ..
6. Religion : ..
7. Nationality/State : ..
8. Branch & Year :
Affix the
... Passport
9. Permanent Address : size
... photo

....
....
Email ID : ......
Phone No with STD Code : ......
(Landline)
Mobile : ......

10. Communication Address : ...


....
....
Email ID : .......
Phone No with STD Code
(Landline) : .......
Mobile : .......
11. Local Guardian Address : .......................
: .......
Email ID : ..............

Phone No with STD Code


(Landline) : .......
Mobile : .......
12. Blood Group : ..............
13. Major illness : .......
14. Name of the Tablet : .......
15. Allergic to : .......
16. Mention the tablet name
That cause allergy : .......

Declaration
I/We declare that the above information give in the application is true and correct to the best of our
knowledge and belief.
I/We hereby agree to obey the rules & regulations of the hostel. If you find any fault against me/us in
obeying the rules of the hostel. I/We accept any action taken by the management.

Name & signature of the Staff Name & Signature of the Parent/Guardian