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MAULANAAZAD INSTITUTE OF TECHNOLOGY (M.P.) BHOPAL.46205I

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APPLICATTONFOR ADMISSION TO THE HOSTEL

* 1 . Narne (ln Capital *2. Sch.No.
Blood Group E-MailI.D.
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Class_Branch Mobib irlo. CATEGORY_(S.C/ST/OBC/GEN/PH)
Mother Tongue

Mother's Name

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Occupation

Address : Phonewith STD CodeNo. 6.
Name & Address of Local Guardian

MobileNo.

Phone No.

MobileNo.

7.
8.

Details dfanydisciplinary action taken by Institute/Ho,stelAuthority:
ResultofPrevious Semester Result Max. Marks % of Marts /CGPA

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II III

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VIII 9. For IstyearStudents AIEEEAll IndiaRank

10. Unde*akingi I undertake that I will abideby the rules& regulations ofthe Instituteandwill not indutgein raggingor any actionconnected.with ragging:failing which I may be punished to the extentof expulsionfrom the hosteV Institute. * Informationmustbe given Signature ofStudetrt'

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.... COW ? .Signaturc of Mess Supervisor Caretaker........ dated........... Warden Hey' Shehasno mess duesand hashanded over roomto Caretaker Hostel AllotmentDetrils..........................Branch . Warden/ Sr......Room No. By DD No"/Challan No.....was rcsiding in HostelNo...................... Warden CQWOffce Chaimlan......... carctaker on Signature of Mess Supervisor...... RoomNo............ Paid mess'advance Rs... Alloted Hostel No........:............_ Warden / Sr.........Name ofBank.....1.......

Guardian Signatureof ParenU Name: Address: 6. the punishment awarded to my wardby the institute I withragging. withregard to fulfilling assignment and studyvisitwhichare essenroomassignments.No. of damage thatmay be caused Myward shallbe responsible for payment negligence. requirements. Telephone withcode No.through of institute ruleshe will be liablefor punishment I declare that in case my warddisobeys authority.project tial partsof the course structure. hasalsogivendirections against for punishment I furtherdeclarethat if my ward is found to be involvedin any act or indiscipline. He shall be open to the disciplinary actionfor violationof any of the rules prescribed lherein. computer laboratory etc.Nnrrornl lrstrrure or TecnuolocY . and discipline withinthe class room hosteland camMy wardshall maintaingood behaviour pus. equipments.462003(M. 4.P. I shallaccept as deemed fit by competent suspension or cancellation of admission authorities.) BHOPAL BY THEPARENT DECLARATION/ UNDERTAKING MAULANAAZAD I hereby undertake to ensure that 1. to library books. My ward shall not damage/deface or spoil the hostel room ( includingthe finishingin the provided by the authorities. am aware that ragging ragging. Mob. 5. in respect of minimum notification. prescribed and other in the prospectus My wardshallabideby the rulesand regulations class attendance. 3. Date: Place: . connected in ragging or anyactivity I undertake thatmy wardwill not involve Hon'ble Supreme Courtand the Government is cognizable offence. examination rules. I shall acceptthe punishmenUDisciplinaryaction taken by the Instituteauthorities against my ward. rooms)and the furniture& equiprpent 2.