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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
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. Father’s 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
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)

For non-residents of Tricity. 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. 11. 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 .

Attach NO DUES SLIP if applicable from the previous Hostel Manager and Attendant with this form. 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. I am liable to be punished and expelled form the Hostel and institute and F. Date: Place: (Signature of applicant) Note:- 1. 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. I will be responsible for any breakage and loss of the room and its furniture. room heater. b) I certify that I was not involved in any offence. with this form. illegal activities. j) I will observe proper decorum and discipline in the hostel mess and club. Attach either the DRAFT OR ORIGINAL AND ONE PHOTOCOPY OF THE DEPOSIT SLIP (if money is deposited in the PNB. I will not consume any intoxicants (liquor. k) I will not install room cooler. 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. l) I will not use electric kettle. 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. A disciplinary action and/or monetary fine can be imposed on me by the authorities and/or student affair committed. Himalaya Hostel account) whatever may be the case. 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. Only completed form alongwith all necessary attachments will be accepted. in my room. h) I will pay my mess/hostel dues regularly and well within the stipulated time period. m) I will reside in the allotted room and will not make mutual interchange of the room with fellow hostlers. 2. water immersion rod etc. intact throughout my stay in the hostel and will handover the same in proper conditions to hostel authority. It is mandatory to give the information of the vehicle owned by the hostel resident. f) I will not leave the station/hostel without the prior permission to the hostel authority. in the room.I. g) I do not owe any thing to any other mess/hostel of the PEC. 4. e) I will not keep any guest in my room without the prior permission of hostel authority. 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. Further my parents will be called/informed about the misdeed done by me in the hostel. Attach ONE MORE SELF ATTESTED PASSPORT SIZE PHOTOGRAPH of yours with this form. expelled from any hostel in previous years and no case is pending against me in any court of law.R. 3. cigarette drugs or any other similar things) in hostel premises. air conditioner etc. . will be lodged/registered against me as per the judgment of Hon’ble Supreme Court. Unauthorized vehicles shall not be allowed to park in hostel. q) I am fully aware that RAGGING IS A CRIME in the institute/hostel premises as per the judgment of Hon’ble Supreme Court if I am found guilty of indulging in ragging. 5. i) I will keep the room and furniture etc.

using of driving automated vehicles of his own or of any other person inside the campus of PEC University of Technology. __________________________ Father/Mother of __________________ students of PEC University of Technology. 10/. 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. Chandigarh. _____________________________ S/o. In case I am found involved in any act amounting to violation of discipline or misconduct or act falling under the definitions. 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. 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. Declared this ____________________ (day) of ___________ month of _________________ (year) (Signature of Candidate) AFFIDAVIT BY PARENTS/GUARDIAN I. and as per rules any student found keeping. indiscipline. Chandigarh.non –judicial stamp paper) AFFIDAVIT BY THE STUDENTS I. Chandigarh shall be subject to appropriate disciplinary action including permanent expulsion from hostel. Signature of Mother Signatures of Father Signatures of Guardian Date : __________________ Place : __________________ . 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. I am aware of the fact that. D/o _______________________________________ resident of ____________________________________________________________________________________ have been admitted to PEC University of Technology.All UG and PG students have to submit affidavit in the following format on a duly notorized on Rs. Breach of above undertaking disciplinary action be taken against me as per university rules. keeping of automated two/three/four wheelers in hostel premises is strictly prohibited. misconduct. Chandigarh in program _____________________ Year ___________ Branch ____________________ and has been allotted hostel accommodation at ___________________________ Hostel at PEC University of Technology.

Panchkula. and Mohali. …………………………… …………………………… 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 . UNDERTAKING 1. 2. I hereby declare that I am not a resident of tricity i. 3. Chandigarh.e. My parents are also not having any permanent residence in the Tricity and are presently not residing the Tricity. 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.