JAI NARAYAN VYAS UNIVERSITY, JODHPUR

Engineering College Hostels Application Form For (New)

Employed student/engaged in business,failures,those doing second post graduate degree, previous hostellers disqualified for admission on account
of indiscipline and misconduct including in unfair practices,students suffering from infectious diseases, local students having own/rented
accommodation,students against whom case has been filed by University/College/Hostel and decision is pending in criminal court are not eligible
for admission in University Hostel.

1 - Roll No - 21UFIA1195
2 - Candidate Name - HARISH KUMAWAT

3 - Degree Name - B.E.(CBCS) IIIrd Sem Mechanical Engineering

4 - Permanent Address - VAYA SHISHU RANOLI VED KI DHANI SIKAR

5 - Student Category - Other Backward Class (OBC)

6 - Mobile No. & Email Id - 8003274108 & harishkkumawat1717@gmail.com
7 - Date of Birth - 15/02/2003
8 - Marital Status - Single
9 - Mother's Name - SAPANA DEVI
10 - Father's Name - SUBHASH CHAND KUMAWAT
11 - Father's Occupation - BUSSINESSMAN
12 - Father's Official Address RANOLI,SIKAR
-

13 - Father's Telephone No. -

14 - Father's Mobile No. & Email Id - 7737371717 &
15 - Name and Address of Local Guardian - SUBHASH CHAND KUMAWAT & RANOLI,SIKAR &

16 - Local Guardian Telephone No. -

17 - Local guardian Mobile No. -
18 - Percentage in last examination - 85.00

19 - Name of the last Examination Passed - 12TH

20 - Name of School/Institution last attended - TEGOR VIDYA BHAWAN SR. SEC. SCH. SCHOOL ,SIKAR
21 - If you were a hosteller MBM in Previous year - No
22 - Room No.
-
23 - Have you ever suffered / Suffering from
any infectious disease - No

24 - Have you ever been convicted or is any

criminal proceeding pending against your - No
court

25 - Give Details -
26 - Emergency Contact Person - 8003274108
27 - Emergency Contact Person Email Id -
28 - Emergency Person Contact No. - 7737371717

29 - Blood group - O+

30 - Entrance Exam passed - JEE

31 - Marks Obtained in Entrance Exams - 44 Total Marks - 100 Percentage - 44.00
32 - Student Remark -

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Hostel Admission Details
Marks Obtained in Total Percent(%) Fee Challan Fee Challan
S.No. Semester Hostel No. Room No.
Exam Marks No. Date

1 Ist 824 74.91

UNDERTAKING BY PARENT/NATURAL GUARDIAN

I SUBHASH CHAND KUMAWAT (Name),Father/Guardian of HARISH KUMAWAT, student of Faculty of Engineering and Architecture,solemnly declare
that the information furnished by my ward is true and correct. I undertake the responsibility of paying hostel fees and other charges payable my ward
from time to time. If my ward remains absent from the hostel without the formal permission of the warden, his/her allotment of room in hostel may be
cancelled. I shall be responsible for the conduct of my ward. The decisions of warden shall be binding upon my ward in all matters. If my ward is
found indulging in any act of indiscipline, the action taken by the hostel Authorities shall be binding on him/her.I undertake to come over to meet
Hostel Authorities whenever called for.

Signature of Father/Guardian

UNDERTAKING BY LOCAL GUARDIAN

I SUBHASH CHAND KUMAWAT & RANOLI,SIKAR(Name of the Local Guardian) agree to act as local guardian of sh. HARISH KUMAWAT student of
Faculty of Engineering and Architecture.I undertake the responsibility of the payment of his/her hostel dues and his/her good conduct. I undertake to
come over to meet the Hostel Authorities whenever called for and will cooperate with warden.

Signature of Local Guardian

Signature of
Date: 17-February-2022 Hostel Warden SIGNATURE OF THE STUDENT

NOTE: Please attached the Hard Copy of Currently Available Marksheet for Last year.

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