Paste Passport MAULANA AZAD. Sie NATIONAL INSTITUTE OF TECHNOLOGY | "*1#P* ‘BHOPAL-462051 (MP) APPLICATION FOR ADMISSION TO THE HOSTEL ‘1, Name (ln Capital Leter = —— #2. Sch. Ne Class Branch, Blood Group Mobile No. E-Mail LD, (CATEGORY, (S.C/STIOBCIGENPH) 93, - State of Domocile Mother Tongue Tchatesnan ce es es eee #5, Fathe’s Name, Occupation Designation & Organisation Address Phone with STD Code No. Mobile No, 6, Name & Address of Local Guardian Phone No, Mobile No, 7. Details of any diseiplinary action taken by Insitute/Hostel Authority: Alig am eesti LSS DESee st omen cee 8, Result of Previous Semester Bomester Result ‘Max. Marks | % of Marks ICGPA WV Vv Vi Vit Vil 9, For It year Stadents AIEEE All India Rank 10. Undertaking ‘= undertake tha [will abide by the rules & regulations of the Institute and will not indulge in rageing or any action connected with ragging: failing which I may be punished to the extent of expulsionfrom the hostel Insitute, “Information must be given Signature of Student wu.'No Dues for student residing in hostel in previous semester * Name___________ was residing in Hostel No. Room No. Her She has no mess dues and has handed over room to ‘caretaker on Signature of Mess Supervisor. Warden’ Se. Warden, CaretakerMAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY BHOPAL 462051 (M.P.) DECLARATION/ UNDERTAKING BY THE PARENT hereby undertake to ensure that My ward shall abide by the rules and regulations prescribed in the prospectus and other notification, with regard to fulfiling requirements, In respect of minimum attendence, Class room assignments, examination rules, project assignment and study visit which are essential parts ofthe course structure. ‘My ward shall maintain good behavior and discipline within'the classroom, hostel and campus. He shall be open to the disciplinary action for violation of any of the rules prescribed therein, My ward shall not damage deface or spoil the hostel room ( including the finishing in the rooms) and the furniture and equipment provided by the authorities ‘My ward shall be responsible for payment of damage that may be caused to library books, equipments, computer laboratory etc. through negligence. | declared that in case of my ward disobeys Institute rules he will be liable for punishment of suspension or cancellation of admission as deemed fit by the competent authority! shall accept the punishment awarded to my ward by the institute authorities. | undertake that my ward will not involve in ragging or any activity connected with raging. | ‘am aware that ragging is cognizable offence. Hon'ble Supreme Court and the Government has also given directions for punishment against ragging, | further declare that if my ward is found to be involved if any act af indiscipline , | shail accept the punishment! Disciplinary action taken by the institute authorities against my ward. Signature of parentGuardian