Plot No: 211/1905 Lewis Road Bhubaneswar

Space for Passport size photograph

1. Name of the Applicant (In capital letters) ______________________________________________ 2. Date of birth____________________ 3. Marital status (Single/Married) _____________________ 4. Occupation: ________________ 5. Blood group: __________________________________________ 6. Father’s/Husband’s Name____________________________________________________ 7. Term/period of Staying From ___________________To ___________________________ 8. Address for Communication _________________________________________________ ____________________________________________________________________________ 9. Full Address of Organization: _______________________________________________ ___________________________________________________________________________
(If Student, Mention the address of Institution) 10. Present Occupation of Father/Husband (With communication address):_________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ 11. Telephone Number: (Mandatory) Self Parent/Guardian Residence Office Telephone No Emergency

12. Proof of Identity._________________________________________________________________________
(PAN/Driving License/Passport/ Any other document issued by Govt to be attached)

13. Email ID: ________________________________________________________________________________ 14. Food Habit Specification: Vegetarian Non-Vegetarian

Boarders not willing to have any particular meal need to provide prior information of such abstinence. They must obtain prior permission from Hostel In charge if any such situation arises. relatives. hotplates. Any deviation from this rule shall be viewed seriously.  Residents are not allowed to stay outside the hostel overnight for their own safety.shall be levied on the boarder concerned.  House Rent. guests etc. in the hostel rooms in strictly prohibited. The boarders can meet outsiders at the front office.  Borders are directed not to allow non-boarders (family members.  No parent or guardian of a boarder is permitted to stay in the hostel.  Lunch & Dinner shall be made available between 9AM to 1 PM & 8pm to 10 PM respectively. other objectionable/hazardous items etc. Canteen fees need to be paid on or before 7th of every month. 200/. resident cannot discontinue her stay for at least one year.00 PM (Night) each day. friends. If outsiders are found in premise entertained by any boarder.  Boarders having laptop can avail wifi internet service at the payment of Rs 50 per month in advance.  Hostel will be opened from 6.  Resident willing to stay outside the hostel or taking leave can be permitted only if their parents or local guardian permission is filed or application is received in advance. No one else will be responsible for their loss and damage. All fans.  Use of electrical appliances like heaters.  A student shall take due care of her belongings. one has to give a one month notice to the in-charge or pay one month rent of the house.00 AM (Morning) to 9. a fine amount of Rs. Gas. light and electrical appliances must be switched off when not in use.Rules and Regulation  Once occupied.) Into the mess premise without due permission of authority. .  In case of leaving hostel prior to the term.

 Residents are not allowed to keep weapons & threatening items or any such items in their possession in the hostel premises. I hereby declared that the information furnished above is true to the best of my knowledge.9.8. suggestion and emergency.00AM-1.  For any service. Full Signature of Boarders FOR OFFICE USE ONLY 1] Security Deposit Amount: RS: 2] Room No: 3] Admit on : Bed NoValid up to Signature of Hostel I/C ( Rupees ) Date . complain.30PM-9. please contact:09861331788.9178189188 TIMING OF MEALS LUNCH. Possession and consumption of intoxicants and any kind of substance is strictly prohibited in the hostel premises  Anyone wishing to go home need to take permission from hostel in-charge one day before.00 PM DINNER.30PM NOTE: There Will Be a Bell before Lunch & Dinner Declaration: That I agree to abide by the rules & Regulation of the hostel I am confident of my ability to work in a team.

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