HOSTEL REGISTRATION FORM FOR JULY TO SEPT. 2021

Important instructions for filling registration form.     Ref.ID 1967 User: 20001009014 Sign out

1. All * fields are mandatory.

2. Click on respective block's Save button to save block's data.

3. After saving all block's data click on Final Submit button.

4. After Final Submit, reference id will be auto-generated.

5. After print user should sign and paste latest picture on reg. form.

Student's Information
First Name * Middle Name Last Name

Ashish Nautiyal

Gender * DOB * Blood Group

Male 10/10/2002 A+

Aadhar No. * Category * Nationality *

992074218584 General Indian

Mobile No * E-mail ID *

8076221188 nautiyal1010@gmail.com

*If user edit any data field after saving

  user should again click on Save button. Save Edit

Residence Information
Mother's Name * Father's Name * Residence Mobile No. *

Sheela Nautiyal Lokender P Nautiyal 8076221188

Alternate Mobile No. Guardian Name Guardian Mobile No.

Min./Max.10 digit length Min./Max.10 digit length

House No Sector / Colony / Village * Land Mark / Post Office

T-49/A-11 Baljeet Nagar, West Patel Nagar

District * State * Pin Code *

New Delhi New Delhi 110008

Distance from residance to DCRUST campus in Kilometer only *

52

*If user edit any data field after saving

  user should again click on Save button. Save Edit

Academic Information
Institute's Name * Programme * Branch *

DCRUST, Murthal UG B.Tech. Civil Engineering

Roll No. * Year * Semester *

20001009014 First 2nd

*If user edit any data field after saving

  user should again click on Save button. Save Edit

Hostel Information
Are you presently Hostler ? * If yes, Hostel No.* If yes, Room No. *

Yes BH-IV Aryabhata Hall 179

Hostel Need From Date * To Date * Total Days *

07/25/2021 07/31/2021 7

*If user edit any data field after saving

  user should again click on Save button. Save Edit

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief.

Student Signature

Office use only

Hostel No. Room Status. Room No.

Office use only Office use only Office use only

Hostel Warden Signature Hostel Supervisor Signature Clerk Signature

Final Submit Print