Application Form

S.R.No. ______________
PHOTO
Enroll No____________

1. Name of the student____________________________________________________________

2. Father’s name _________________________________________________________________
3. Mother‘s name_________________________________________________________________
4. Date of Birth___________________________________________________________________
5. Preparation ___________________________________________________________________
6. Father’s Occupation____________________________________________________________
7. Address (In Block Latter)_______________________________________________________
________________________________________________________ Pin code______________
8. Student Mobile No.________________________ Parents Mobile No._________________
9. Aadhar Card No. / Voter ID/ PAN No. ___________________________________________
10. Name of local guardian ________________________________________________________
11. Local Address _________________________________________________________________
Pin code. ___________________________Local guardian Mob No.____________________

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Declaration By The Student

I agree to pay the Library Fees Bills on receipt from the contractor and also the rentals and
establishment charge etc. Shall be paid at the time of admission to the library.

We have gone through all the provision contained in the rules and regulation thoroughly and will
abid these rules and regulation.

I certify that the information given above is true and correct. It any conduct during my stay is found
unsatisfactory, due to my negligence, misbehavior & Indiscipline, I agree I will abide by your decision. I will immediately
vacate the library ordered to do so.

Date: _________________ Signature. of the Student: __________________________