RSET Campus, S.V.
Road, Malad West, Mumbai-400064
Tel:9004032061, Email:
[email protected] Website:www.jbbh.org.in
Academic Year: 2023-2024 Application
No.:
12 Month Quadruple Sharing 1474108
Date .: 18-
08-2023
HOSTEL APPLICATION FORM
The Rector,
Sunder Nagar, Malad West, Mumbai
Tel: 9004032061 | Email: [email protected] | Website: www.jbbh.org.in
Sir,
I wish to apply for accommodation in RSET' Jankidevi Bilasrai Bubna Boys Hostel for the academic year 2023-24
Personal Details :
Full Name : Dixit Aman Kumar Renu dixit
(in capital letters) Surname First Name Father's Name Mother's Name
Date of Birth : 2004-01-21 Place of Birth : Lucknow Dist. of Birth :
State of Birth : Uttar Pradesh Gender : Male Marital Status : Unmarried
Aadhar Card No. : Nationality : Indian Religion : HINDUISM
Community : BRAHMIN Mother Tongue : Marathi Blood Group : O+
Reserve Category : OPEN Caste : HINDU Sub Caste :
Domicile Maharashtra : Email : [email protected]
Contact No.(Res) : Mobile No : 9559999513 Health problems :
Address : J-403 Indralok colony, Krishna nagar J-403 indra lock col
City : Lucknow State : Uttar Pradesh Country :
Pincode : 226023
Native / Permanent Address : J-403 Indralok colony, Krishna nagar J-403 indra lock col
City : Lucknow State : Uttar Pradesh Country :
Pincode : 226023
Repeater Tag : Fresher
Father's Details
Father's Name :(Surname First) Dixit Kumar
Qualification : DIPLOMA Occupation : GOVT.EMPLOYEE Annual Income : 600000
Name & Address of the Organisation : EEEUDD Aishbagh Lucknow
City : Lucknow State : Uttar Pradesh Country :
Pincode : 226004
Contact No.(Office) : Mobile : 9956834000 Email : [email protected]
Mother's Details
Mother's Name:(Surname First) : Dixit Renu dixit
Qualification : GRADUATE (BA) Occupation : HOUSEWIFE Annual Income :
Name & Address of the Organisation : J-403 Indralok colony Krishna Nagar
City : Mumbai State : Uttar Pradesh Country :
Pincode : 226023
Contact No.(Office) : Mobile : Email :
Local Guardian 1
Full Name : Rajkumar tiwari
Address : Sanchit sarini hsg. Soc. H.k.road iit Powai
Pincode : 400076
Contact No.(Office) : Mobile : 8828291158 Email : [email protected]
Local Guardian 2
Full Name : Santosh pandey
Address : IIT POWAI CHAITANAYA NAGAR
Pincode : 400076
Contact No.(Office) : Mobile : 8828291158 Email :
Current Education Details:
Institute Name : - Course : BLS LLB Honours Course Start Date : 25-08-2023
off, topiwala marg, off,
bandugore marg, near
Course End Date : 25-08-2028 Course Duration : 5 year Institute Address : sarswati junior college
goregaon west mumbai,
maharashtra 400104
How did you come to know about the Hostel : Social Media
I request for admission in Jankidevi Bilasrai Bubna Boys Hostel.
1. I declare that information appearing in the form is true & correct to the best of my knowledge & belief.
2. I declare that my age as on date of application is more than 18 years and less than 30 years.
3. I further declared that I have read all the rules and regulations and I hereby give my undertaking to abide by the present
rules as well as future rules framed by the management from time to time.
4. I shall also abide by the circulars and communications by SMS and/or Emails & notices issued by the Management from
time to time
5. I understand that the Management of Hostel is free to take any action including cancellation of my admission to the hostel
if I am found breaching any rules / regulations. The fee for remaining period will not be refundable in case of expulsion from
the hostel by the management.
6. I shall not remain absent from the hostel without prior written permission from Rector / Warden.
7. I shall not enter / leave the hostel late (i.e. beyond the permitted time, i.e 10:30 pm.
8. I will vacate the hostel and hand over the vacant possession of my hostel room immediately at the end of my hostel term.
9. I understand that fees once paid will not be refunded under any circumstances.
10. I shall maintain the dignity and sanctity of the hostel by not creating any noise / nuisance etc.
11. I shall not cause any damage to the hostel premises including furniture and fixtures.
12. I am conscious about the cleanliness and shall maintain the same in my room and surroundings.
13. I shall switch off the lights, fans, other electrical appliances and/or air conditioner etc. when not in use.
14. I am aware that my admission, if any, is for the current term only and renewal of the next term shall be solely at the
management's decision based on my following of Institute's rules and regulations.
15. In case of any change in the above information, I will inform the Institution immediately in writing within three days.
16. I confirm that I am studying or doing articleship in Mumbai region and on change of my educational institution or
articleship from Mumbai region during the course of term; I will vacate the Hostel immediately. Also in case I leave my
course in between the term, then also I will vacate the hostel immediately.
Yours Sincerely
Signature of Applicant
Signature of Parent
Date:________________________
Documents to be submitted with the admission form:
1. Two Passport size photographs of the student and parents (give in an envelop, with your name written on it).
2. Attested copy of Ration Card, Passport, Aadhar card etc. of Applicant, Parents and both local guardians, for proof of
correspondence address.
3.
a. Photocopy of the "College Admission Fees receipt".
b. In case of CA Articleship: Attested Copy of Articleship Registration letter, Copies of Form 102 & 103 with acknowledge by
ICAI and a Letter from Chartered Accountant Firm in the prescribed format.
4. Undertaking from Local Guardians in the prescribed format along with latest photograph & photo copy of the PAN Card or
any other Government issued ID card.
5. Latest Medical Fitness Certificate from Practicing Doctor and Blood Group Report.
6. Attested Copy of Medical Insurance Policy of minimum Rs.1 Lakh.
Note: In case you are unable to procure Attested/True Copy you should carry your original documents during submission of
form.
UNDERTAKING FROM LOCAL GUARDIAN
Date: __________________
To,
The Warden
Jankidevi Bilasrai Bubna Boys Hostel
Sunder Nagar, Malad West,
Mumbai 400064
Dear Sir,
I __________________________________________________ personally know Mr._______________________________________.
He is my __________________ (Specify Relation) and I am his local guardian.
He has applied for admission in Jankidevi Bilasrai Bubna Boys Hostel. I request you to please consider his application for
admission in your hostel. I assure you that he will follow the rules & regulations of the Hostel.
I undertake to indemnify your Hostel for any loss occurred due to any act of above student. I also undertake to pay all
dues payable by the above student, in case of his failure to pay the same in time.
I confirm & assure you that Mr.____________________________________ does not have any bad habits like smoking, chewing
tobacco, drinking liquor, eating pan, pan masala & gutka etc. In future, if you find him with any of bad habits, you may
please take strict action against him.
In case he violates rules & regulations of the Hostel, you may take strict action including cancellation of his admission
and removal from the hostel without any prior intimation to me.
In case of an emergency or even otherwise I assure full co-operation as Local Guardian of the applicant student and shall
discharge my responsibility to the best of my ability.
Thanking You,
Yours faithfully,
(Signature)
Name: ____________________________________________________________________.
Address:__________________________________________________________________________________________________
Telephone No.:____________________ Mobile No.:___________________________
Email Id._________________________
Encl: Latest Photograph (Passport Size) & Xerox of PAN CARD.
For CA Articleship Student
LETTER FROM CHARTERED ACCOUNTANT FIRM WITH WHOM STUDENT IS PURSUING ARTICLESHIP
Date: __________________
To
The Warden
Jankidevi Bilasrai Bubna Boys Hostel
Sunder Nagar, Malad West,
Mumbai 400064
Dear Sir,
Mr. ___________________________________________ has been registered as an Articled Student in our firm with effect
from______________ to _____________. His Registration No. is ________________ dated _______________. He is entitled to appear
in Final Exams in __________ (Month & Year).
I/We request you to grant him admission in the current term. I/We assure you that he will abide by all Rules & Regulations
of your Institution & maintain discipline in the Hostel.
I/We also undertake to intimate you in case his article-ship is terminated/extended by our firm for any reason.
Thanking You,
Yours faithfully,
For M/s.________________________________________
Signature: ____________________________________
Designation: __________________________________
Membership No: ________________________________
CA Firm Registration No.: __________________________
Rules and Regulations for Admission and stay in the Hostel
1) The applicants shall furnish true information in the application forms and if the admission is secured on the basis of
false / incorrect information provided, the admission so granted shall be liable for cancellation without any refund.
2) The admission will be valid for tenure/term chosen at the time of admission. A fresh application has to be submitted for
renewal, 30 days prior to the expiry of current tenure. The student shall vacate the hostel accommodation on or before
the due date of the expiry of the term and hand over the possession to the Warden.
3) Hostel accommodation fee including Refundable Security Deposit shall be paid in advance at the time of admission
and the fees so paid shall not be refunded under any circumstances.
4) Cancellation of admission by student: If a student cancels his admission, the hostel fees will not be refunded. Only the
security deposit will be refunded.
5) Rajasthani Sammelan reserves the right to allot the hostel facilities to the eligible candidates only and also has the
right to cancel the admission without assigning any reason.
6) Rajasthani Sammelan Education Trust reserves right to revise the hostel fees, if necessary.
7) Applicants should have a valid medical insurance of at least Rs. One Lakh to secure hostel accommodation and a
photocopy of the same shall be submitted.
8) Students residing in the Hostel shall strictly abide by all the applicable Rules and Regulations in force and as amended
from time to time. Breach of any of these rules / regulations may attract fine and rustication.
9) Students are under supervision of the authority/staff designated for the purpose like Warden, Hostel-in-charge etc. and
shall follow the their instructions for smooth functioning and management of the hostel.
10) Smoking, consumption of alcoholic drinks, consumption of narcotic substances in any form, chewing of Gutka and pan
masala /pan and spitting is strictly prohibited in the hostel premises. An occurrence of such behavior shall invite strict
disciplinary action leading to rustication from the hostel.
11) No guests or visitors shall be permitted to visit rooms. Bonafide visitors and guests shall be received in the Reception
area only between 0900 hrs to 1800 hrs with prior permission of the Warden. All visitors will be required to fill in their
details in the visitor’s register at the reception.
12) Every student shall be in his room in the hostel by 2230 hrs. Student shall not be allowed to leave the hostel in the
night i.e. from 2230 hrs to 0530 hrs. However, if situation so warrants that he has to be out of the hostel beyond 2230 hrs
or go out of hostel before 0530 hrs, he shall take permission from the Warden in writing with sufficient proof of such
situation and if the Warden has sufficient reason to believe the facts , may permit the occupant in writing to stay out/go
out as the case may be.
13) Students shall not be allowed to deal with the housekeeping staff or such other staff working in the hostel directly.
For any complaints, they shall contact the Warden or his designates.
14) Students shall not deal with any staff for any personal work on payment or otherwise and also will not be permitted to
bring any servant/assistant from outside.
15) Students shall not swap their rooms and shall strictly stay in their allotted rooms. The student of one room shall not
be allowed to stay in another room and breach to this rule will attract disciplinary action.
16) Students shall report to the Warden immediately for assistance in case of sickness or accident.
17) Under no circumstances students shall be allowed to host any function or celebrations or such other activity in their
rooms or in any part of the hostel. However, in case of birthday, with permission of the Warden the students may cut the
cake at the common area or the dining hall as suggested by the Warden.
18) Hostel is designed with utmost care and the ambience and ethnicity shall be preserved by the students and hence no
student shall put up poster on walls, doors or any part of the hostel premises.
19) Student shall be duty bound to preserve and protect the property of the hostel at all times and shall report to the
Warden for damages caused for undertaking repairs.
20) Students shall not indulge in any sports activity in the hostel/rooms and refrain from throwing water/colour or any
other object on one another or writing of any graffiti on walls, lifts or any other places.
21) Student shall not be allowed to stay in the hostel if a registered medical practitioner certifies that the student is
suffering from an infectious disease that could be transmitted to other students.
22) Authorities cannot be held responsible for the mishap, injuries & accident caused to any of the inmates in the hostel
campus.
23) The Hostel without any prejudice or bias tries to maintain uniformity among all students while allocating rooms and
beds and shall not entertain any complaint in this regard.
24) Students shall keep their rooms neat, clean and tidy and they shall take utmost care of the furniture and fixtures etc.
provided/allocated to them. The hostel authorities have the right to enter and inspect the rooms at any time, even in the
absence of students.
25) Any complaint shall be brought to the notice of the Warden immediately, who shall take such action as deemed
appropriate under intimation to the complainant. No police complaint should be lodged by the occupants without prior
intimation to the Warden/ Management.
26) Students are encouraged to save electricity and switch off the lights and AC of their rooms every time they go out
and take precautions to minimize electricity consumption.
27) Students shall be liable for paying for any damages caused due to negligence or otherwise to the property that has
been provided in their respective rooms.
28) The Hostel Authorities or the Trust shall not be responsible for the safe custody of the belongings such as laptop,
mobile, cash etc. of the students staying in the hostel. Students shall keep all such costly material under lock and keys.
29) If any of the facilities provided at the hostel are misused, the hostel authorities shall discontinue the use of such
facilities without giving any notice and disciplinary action will be taken against the occupants indulging in such activities.
30) If any student is found misbehaving, he will be expelled from the hostel immediately and the fees paid by him shall
be forfeited.
31) It is mandatory that for every request for night out written permission via e-mail/fax/letter etc. from the parent will
have to be taken 48 hours in advance. The absence of the occupant without such written permission from his parent
shall be treated as unauthorized absence and hostel shall be free to take disciplinary action against the occupant. The
reason for staying out of the hostel has to be mentioned for seeking the approval.
32) No music system is allowed in the hostel.
33) Students shall be provided with mattress, pillow and bed linen from the hostel. They have to bring their own blanket
and other linen.
34) No cutlery shall be provided to the students in the room. However, they may bring their own cutlery i.e. glass, spoon,
plate, flask etc. if they so desire.
35) Permission to leave the hostel during off working hours on account of leave to go home or elsewhere or temporary
stay out of the hostel shall not be granted or permitted, without proper requests in writing from the parents.
36) In case a student fall sick, he shall report to the Warden or his designate immediately. Warden shall the necessary
action as deemed fit and inform his parents/ local guardian about the sickness. However, the expenses incurred for such
consulting and incidental expenses shall be borne by the concerned occupant only.
37) If the absence from the hostel is due to hospitalization, the student shall inform the warden and shall be required to
submit the documentary evidence for the period of absence on reporting to the hostel.
38) If the parents desire to take their ward home for longer duration, they shall be required to submit a written
application to that effect.
39) Parents shall be allowed to meet their ward in person only on first Sunday of every month. The Hostel management
may relax this condition depending on situations.
40) Ragging in all forms is strictly banned as per rules and any violation of the same shall be severely dealt with.
41) Students shall carry their Hostel ID card with them at all the times and produce the same at the time of entry to the
hostel.
42) Students shall not be allowed to remove any article or material from the dining room, mess etc. to their room.
43) Students shall not be allowed to use any heavy duty electrical appliances.
44) Each student will be provided a key of their room door and the student is expected to keep it safely.
45) Each student will be provided a key of their allotted cupboard and are advised to keep their belonging safely in the
cupboards assigned to them. The hostel management will not be responsible for any loss of personal belongings.
46) Students shall NOT make or use duplicate keys. Any entry in the room with a duplicate key shall be considered as
trespass and shall be severely dealt with. In case of loss of keys, the matter must be immediately reported to the
Warden. The Warden shall take the necessary steps as per the security policy of the Rajasthani Sammelan Education
Trust and issue a new key after charging the fine as determined by the hostel.
47) Occupants shall not be allowed to screen any unauthorized/ unlicensed movies/ads/clippings/MMS etc. in the hostel.
48) Mass fine will be levied for the following unauthorized activities:
a) Cooking in the Hostel Room
b) Spoiling the wall
c) Spoiling the T.V/AC or any other appliance provided in the hostel
d) Spoiling the furniture & fixtures
e) Keeping the geyser and taps on
f) Any activity leading to loss or damage to hostel property.
49) Following actions to be taken in case of contraventions of any of the rule/s mentioned above.
1st Offence – Warning letter in writing
2nd Offence – Final warning letter in writing
3rd Offence – Immediate Expulsion
50) In case of emergency or mishap, the hostel authorities and the management reserve the right to take appropriate
decision as required.
51) The student shall fill the Undertaking form , which has to be counter signed by the local guardian and handover the
same to the hostel administration.
52) Non vegetarian food and eatables are strictly prohibited in the hostel premises.
53) No inflammable material like fire-crackers, candle, scented candle and match sticks etc. are to be brought to the
hostel. If any of these items are found, the student shall be warned and will be responsible for the consequences.
54) Suggestions & complaints shall be written in respective registers.
55) Students shall keep their rooms, recreation area and surrounding areas tidy, neat and clean at all times and shall not
throw anything including litter in such places or any place in the hostel except in the dustbin. No wet clothes should be
dried on the furniture or hung in the room. Warden has right to confiscate any such clothes hung for drying in the room.
No student shall store any cooked food in the room and they are not allowed to take dining hall cutlery in their rooms.
56) Strict silence shall be observed in the hostel from 12.00am to 6.00am. Care should be taken at all times to ensure
that music, loud talking is not audible outside the rooms.
57) In case of any violation, infringement, contravention of any act or any of the provisions of any act, or law of the land
for time being in force, the occupant himself shall be responsible at his own risk and consequences.
Fee
1) The student who accepts the admission rules and regulations shall pay the fees and refundable security deposit, as
applicable from time to time and until amended. Fees is to be paid online, on the link which is sent to the registered
mobile number of the student.
2) Breakfast and Dinner charges are included in the hostel fees.
3) Laundry and ironing charges for personal clothes will be borne by the students.
4) Security Deposit shall be refunded after deducting or adjusting the amount for any damage caused to the property of
the hostel.
