MARRIED HOSTELS

APPLICATION FOR ALLOTMENT OF ACcOMMODATION TO MARRIED PH.D/M.TECH STUDENTS

1. Name of applicant (In Capital Letters) LAXMAN SINGH KHANGAROT
2. Father's Name: Mr. Raghuveer Singh Khangarot
3 Mother's Name Late. Smt. Sagar Kanwar
4. Class:.. Ph.D. (QIP) CSE
..... Deptt...... I st
Year. ' ' ' ''''**' **'' ' ' **''* *'''*** '***

5. Marital Status. Married D a t e of Birth. 13/01/1984 .Enrl. No..21911018

6. Complete Home Address B-391, Karni Nagar, Lalghar, Bikaner (Rajasthan) - 334001
* * * * *
**************
*** ** .. . . ... ......
********'******'******1

, Address of sponsoring Institute.. Bikaner Technical University, UCET Bikaner Campus, Pugal Road, Bikaner
***''' '**''*** '*'****'''** '*** '* *** ''*******'**** ***

(in case of sponsored candidate)

***** '*****'****'* ********* ********* ***** **** ***** *********
8. Name of scheme/source from which
QIP
the scholarship will be paid .
9 Present Hostel accommodation. Date of occupation.. 03 April 2022
Room No. F-51 Bhawan. Azad Bhawan
10. Date of Joining of IITR in present class:... 18/12/2021
11. Date of Registration
full-time registered
as
Ph.D. Scholar/M.Tech. student. **********°***°'**
18/12/2021
''** **************** ***** * * *** *******
12. Preference ofthe room and hostel for which application is being submitted
S-32 (GP) I. G-22 (GP)... T-22 (GP) .IV. T-28 (GP) V. G-37 (GP) T-30 (GP) Q-3 (VK) Q-9 (VK)
** ****** ******* ***********'*****

. .V ..... VII.......
********* VII....
IX..R-6
**
(VK) R-16 (VK) ***'******
A. XI..S-32 (MRC)
*****************
T-26 (MRC)
XII.*****'** * * XIlI
T-22 (MRC) S-30 (MRC)
...XIV... X V .T-30
.
. (MRC)
. **:** **.

XVI. S-4(MRC) XVII. S-16(MRC) XVIII. 18(AW) XIX. 19(AW) XX. 21(AW) XXI. 39(AW) XXII. 44(AW) XXIII. 45(AW)
XXIV. 46(AW) XXV. 47(AW) XXVI. 55(AW) XXVII. 54(AW) XXVIII. 53(AW) XXIX. S-9(GP) XXX. S-3(GP) XXXI. S-3(VK)
DECLARATION:

(a) I am a full time and registered Ph.D. scholar/M.Tech. student.

(b) I am a married person and will stay in the hostel with my family
(c) I have carefully read the allotment rules and regulations in force given overleaf and shall abide
by them.
(d) I shall vacate the accommodation as and when required by the Institute and shall not have any
claim for any alternative accommodation.
(e) I have carefully given the preference for room and hostel and shall accept the room allotted to
me. I fully understand that in case I do not accept the allotment. I shall be debarred for a period
of six months
() The room, once allotted, will be occupied in the same condition, else my claim shall be forfeited
for any further allotment for six months.
Mobile. +91 9413040982 .E-mail....ls_khangarot@cs.iitr.ac.in

Dated 18-07-2022 Full signature of the applicant

* * * *** '*''' '*'''**'**** '****'*******''' ''************* ''**: * . . .. . .

CERTIFICATE FROM THE HEAD OF THE DEPTT.

- - -
(a) Certified that Sri./Km. LAXMAN SINGH KHANGAROT .is full time
a registered Research
Scholar/M.Tech.
- - - - - student.
-- He has joined the deptt.on. 18/12/2021 ...and has been
getting
QIP
the scholarship/fellowship/salary from... ...which will be paid through Accountss
office of this Institute. The tenure of scholarship will be from... 18/12/2021 17/12/2024

- - - is a married person and will stay with his/her family. This fact is known to me and I verify
(b) He/She
the same. He/She
- - - may be allotted hostel accommodation in married students' hostels

Head of the Deptt.

Dated Guide/Supervisor Dated

(Dharmendra Singh) Seal