Application Form for Allotment of Accommodation at Indicus Trainees

Hostel Central Institute of Brackishwater Aquaculture

75, Santhome High Road, M.R.C. Nagar, Chennai-600028
Name Daggumati Sujatha
Designation NA
Full Official (if employed) or H.No.4-35-499/1, Vinjamoori Vihar,
Full Residential Address Madhavaram Nagar Colony,
Kukatpally, Hyderabad – 500072
Contact Detail Mobil Office E-Mail
7013312549 sujathadaggumati@gmail.com
Double dose of Covid-19 Yes No
vaccination done? (Please tick)
Purpose of Visit (Please tick) Official Private
Description of Visit To attend Workshop cum hands-on training practices on “Biofloc
production technology” from 1st May 2023 to 4th May, 2023
Category ICAR/SAU Serving Private Foreigner
Serving or Central/State Visitor SAARC/Others
retired Govt./ Autonomous
/ PSUs
Duration of stay Check-in Date: 01/05/2023 Check-Out Date: 05/05/2023
Check-in Time: 08:00 Hours Check-Out Time: 12:00 Hrs
Accommodation Type Double bedroom Three bedroom SEPTET
(Double occupancy) (Triple occupancy) (7 beds)
Total No. of persons (Please 1 (one)
mention age of accompanying
children)

Date: 20/04/2023 Signature

To
The Director
Central Institute of Brackishwater Aquaculture 75, Santhome High Road, Chennai-
600028
Ph. No: 044-24618817, 24616948, 24610565, Ext: 700
Fax: 044-24610311 ; Email: director.ciba@icar.gov.in

For Official Use Only

Recommended for Double Bed Room (s) / VIP suite

From ______ To ______ for ____ Persons.

Available / Not available
Room No.

OIC, Trainees Hostel Authorised Signatory