Aeplcationo. 239763 ‘St Gosaltes Application Fee: Rs.500/- SRI GOSALITES Medical Academy VUAYAWADA (sponsored by Sr Gosalites Educational Sodety) es °. 10. a. 2 ua 35. 16. {Fitiek inthe right column ‘Campus of Admission : APPPLICATION FOR ADMISSION INTO HOSTEL Phota in Full with Surname | 20th Sylabus (ssc FJeose (]icse ate ot airth: Previous Schoo! / College Details : (aper 850 / Cqubvatent exare Standard | Aeaderieyeat | ‘Name of the School /Collene [Grade/Warks | CGPRT 10th | ‘Application No.: Confirmation Fee Student Aadhar No. Gender E]mae _ [)Femate Name of the Father Name ofthe Mother I I Admission Into [lwumior iwrer [senior wer [tons rena [loner eure crauencers EJo-neer eure cuauiencens ([]c-neer eure cvaurenceas (Conecr euws eve (Cs-neer aus eve Cleneer ous eve Second Language: [] Sanskrit{] rabie [[] Frenen Sibling details: 1) Student Name schoo! Name cass 2) Student Name school Name class Address for Commoniation: Door No. /Street Name: Village / Mandal : City / Town District, : Mobil Mobile-2 uatfyng Examination: [-]intermediate [-] CASE (62) [[] Other Year of Pass Mall Ticket Number: Markssecured + 1 Neer DETAILS : Mall Ticket No, ans| an| EAMCET DETAILS —_: Hall Ticket No. anns| an| University Area to which the Candidatebelongsto =: Jau-Jou [}svu [Jotier Reservation Category Def (Cece Face One Cs Gist Fisoors Cjear Chen ‘Application Fee 232763 fe SRI GOSALITES Medical Academy VUAYAWADA (sponsored by Si Gosalites Educational SocietyCANCELLATION OF ADMISSION AND ACCOUNT SETTLEMENT riven any reeebt the terms & conditions laid down the institution forthe fee structure. 1am aware of the deduction ven and refund formalities of the fee (I have relfered to the format given below For MOSTELLERS: s u Sefore ONE month Rs. 20,000/. will be deducted. Before TWO months Rs. 30,000/- will be deducted. Before TAREE months Rs, $0,000/- will be deducted. Before FOUR months 50% will be deducted. After A months No fee will be relunded. Note: 2) Confirmation fee is non refundable i, for hostellers Rs. 5000/- 2) Additional amount will also be deducted. If cancellation is applied after confirmation. In this regard, Management's decision is findl 3) Original fee receipt must be produced along with a requisition letter for the settlement of account refund. UNDERTAKING BY THE STUDENT: 1 will follow the discipline of the institution and strictly adopt anti-ragging policies. In the event of my misbehavior, | will not question the action whatsoever taken by the authorities of the institution, a3 3 part of discipline, including my expulsion. | am informed by the management that electronic items like cell phones, Ftd ‘adios, Video games etc., should not be brought into the campus. UNDERTAKING BY THE PARENT/GUARDIAN: + Iwill abide by the rules and regulations laid in the prospectus. | will submit all the originals afong with the Photocopies of certificates and Passport size photos at the time of joining my ward in the Institution. + {will furnish the names of the authorized visitors along with thelr photos at the time of admission of ward. | will ot insist on the management to permit any visitor other than those whase names are furnished by me on the visitor's card to meet my ward. + I know that the fee paid towards admission is not refundable in any case. Cancellation of admission or settlement of account is as per the conditions mentioned above by the management. If my ward/visitor/misbehave or create any disturbance on the campus, the ward will be terminated from the Institution, The institution will not bear any kind of responsibility for my ward's behavior outside the campus. if my ward leaves the campus without obtaining prior permission from the administrative authorities of the campus concerned, the institution's authorities are not held responsible and | myself will take up the responsibility of my ward. understand that such actions on the part of the student may result in the transfer of the student from the residential campus to the day-scholar's campus or will be terminated from the institution. + Fee paid for my ward will not be transferred to another student in any case. + Ifwantto shite my ward from your institution to ather before completion of two years cours, | shal given at the time of admission. kof the concession +The Course fee does not include course material + Allotment of campus and section is at the sole discretion of the management. ‘The management reserves the right to shift the students from one campus to another campus. + Fee concession, if offered, will be valid for that academie year only. Service Tax will be collected separately, wherever applicable. + Permission can be given to my ward, if he wishes to go out from the campus on any urgency or during the common outing. Alter | have satisfied myself with the facilities, conditions, rules and regulations of the institution and the hostel, | am willingly admitting my ebild FOR OFFICE USE APPLICATION : ACCEPTED / REJECTED JUNIOR INTER SENIOR INTER LONG TERM TOTAL FEE GENERAL CONCESSION EXTRA CONCESSION, IF ANY : FINAL FEE TO BE PAY : ‘Admission Done by g Course opted : Date of Admission Signature of the Student Signature of the Parent/Guardian PRINCIPAL ‘SRI GOSALITES Medical Academy ACHNOWACOGEMENT / CASH RECIPE Adoisionty — + Phone Number StudentName = Father's Name Course opted ‘Authorised Signatary bate