AMITY HOSTEL

REGISTRATION FORM [2021-2022]

Personal Particulars

Name ABHAY SINGH TOMAR

Batch 2020-2024
Mobile No 8918196486
Email ID abhay.tomar@s.amity.edu
Programme B.Tech (Computer Science &Engineering)
Enrollment No A60205220180
Blood Group B+ve

Family Particulars

Father Detail Mother Detail

Father Name BHARAT SINGH Mother Name SUNIL
RETIRED GOVERNMENT NON
Occupation Occupation HOMEMAKER
GAZETTED OFFICER
Address MADHUPURI COLONY AMBAH Address MADHUPURI COLONY AMBAH
Mobile No. 7879406664 Mobile No. 9826452737
Landline No. Landline No.
Email ID tomarb77@gmail.com Email ID

Local Guardians Details

Local
Guardian 1 Local Guardian 2 Detail
Detail
Name SHIVAM BHADORIA Name AKANKSHA
Relationship BROTHER IN LAW Relationship SISTER
Occupation ENGINEER Occupation HOMEMAKER
Address CHAR SHAHAR KA NAKA GWALIOR Address CHAR SHAHAR KA NAKA GWALIOR
Mobile No. 9826452737 Mobile No. 6397271941
Landline No. Landline No.
Email ID Email ID

UNDERTAKING
1. I hereby affirm that I have read and understood Hostel Regulation VI, and the hostel allotment is made to me under Regulation
VI, Para IV &V(Terms &Conditions for Hostel Allotment) .
2. I understand that it is mandatory for me to read the University Regulations, Guidelines, Hostel Code of Conduct and Student
Handbook, available on my Amizone.
3. I convey my willingness to accept the Hostel Accommodation ON/OFF campus as allotted to me.
4. I certify that the above information is correct.My Hostel allotment may be cancelled and hostel fee forfeited, if any of the above
information is found to be incorrect.
5. I will inform the hostel administration immediately of any change in the status of the above information.

(Signature of Student) (Signature of Parents)

Name:_________________________ Name:_________________________
Date:_________________________ Date:_________________________

For Hostel Office use only

Date &Time : _________________________ Received By : _________________________