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

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