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NATIONAL

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.
r,3. Stateof Domocile
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Class_Branch Mobib irlo. CATEGORY_(S.C/ST/OBC/GEN/PH)
Mother Tongue

Mother's Name

'r5. FathelsName Designation & Organisation
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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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... carctaker on Signature of Mess Supervisor.....Branch .... RoomNo...Room No....... Warden CQWOffce Chaimlan............. Warden/ Sr... Warden Hey' Shehasno mess duesand hashanded over roomto Caretaker Hostel AllotmentDetrils..... Paid mess'advance Rs..............Signaturc of Mess Supervisor Caretaker............ By DD No"/Challan No......Name ofBank.......................................... Alloted Hostel No.... COW ? . dated......_ Warden / Sr.......was rcsiding in HostelNo.:................1....

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