Hostel Admission Form for new students (Fresh Admission) (Session 2019-20)

For office use only.

Hostel Hostel Roll Hostel Room
                         
Name No No
Name of the
1. POOJA JAIN
Applicant
2. Nationality INDIAN Gender Female
Blood
3. Date of Birth 13/10/1998 B+
Group
MBA(FINANCIAL
4. Application ID 301900029241 Class MANAGEMENT) SEM-
I
5. Department UNIVERSITY BUSINESS SCHOOL
Are You availing Loan From
6. No
Bank
7. b) Guardian's
Father's Name SEEMA
7.a) DEEPAK JAIN  
Name (If, Father is not JAIN
there)
c) Address: Father's/Guardian's Address Local Guardian Address
HOUSE NO 5C
HOUSE NO.5CSTREET NO.2
STREET NO 2 BASTI
Address Address BASTI TANKAN WALI
TANKAN WALI
FEROZPUR CITY
FIROZPUR CITY
City FIROZPUR
City FIROZPUR
Pincode 152002
Pincode 152002
State PUNJAB
State PUNJAB
Phone 8559052851
Phone 9815934070

Father's/ Guardian's
d) BUISSNESS MAN
Occupation
e) Residence Phone No. 01632-246580
Father's /Guardian's Annual
f) 90,000 (In Rs.)
Income
g) Shortest distance 1000 (In Kms.)
8. Belong to Schedule Caste/Tribe? No
9. Are you suffering from some chronic disease? No
10. Have you ever been punished for misconduct/violating the No
 hostel rules/ indiscipline etc.?
DECLARATION
I, POOJA JAIN hereby declare that the information filled by me in this form is true, correct and complete to
the best of my knowledge and shall hold myself responsible for any false entry. I have read the rules of the
Hostel and have noted and understood that these rules will strictly apply on my admission and stay in the
hostel and shall follow them accordingly. I shall pay the Hostel dues from time to time, as required. I will
vacate the Hostel Room within a week from the last date of examination of current session.

Date:_________________________   Signature of the Applicant

I, recommend that POOJA JAIN Class MBA(FINANCIAL MANAGEMENT) SEM-I be admitted to the University
Hostel. He/She has paid the Departmental fees. The Department takes the responibility of his/her good conduct
and payment of dues/expenses of the hostel. He/she will be issued the Examination Roll No Slip on Production
of "No Due Slip" from the hostel office.

Signature, Head of
Date:_________________________ Department