FT/GN/47A /00/13.06.
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SRI VENKATESWARA COLLEGE OF E3NGINEERING
HOSTEL ADMISSION FORM
I YEAR II YEAR III YEAR IV YEAR
Room No: Room No: Room No: Room No:
1. Name of the Applicant…………………………………………………………………………………………………
2. Course…………. year of joining ……………. Branch………….college I.D. No…………………………...
3. Name of the Parent/ Guardian………………………………………………………………………………………..
Occupation……………………………………………………………………………………………………………………..
Residential Address…………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………….
………………………………………………………Pin code……………………………… Telephone No……………………….
Cell No (Student)………………………Cell No (Father)……………………………….Cell No (Mother)……………………
4. Name of the local Guardian if any)…………………………………………………………………………………………………
Occupation………………………………………………………………………………………………………………………………………
Residential Address………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………
Telephone No……………………………. Cell No ………………………………….. Cell No. ………………………………………
5 Blood Group…………………………….. Allergy to any specific drugs to be indicated……………………………….
6. Any specific medication being followed:
7. Medical problem if any:
DECLARATION AND UNDERTAKING
➢ I hereby state that all the above statements are true to the best of my knowledge and belief.
I will update the above details and when they change.
➢ I shall abide by the hostel rules in force at any point of time.
➢ I accept to abide by the disciplinary action imposed by the Hostel authorities.
➢ I accept to pay the administrative charges, repair and maintenances charges as levied by
hostel management
➢ I am aware that this allotment is valid for a particular academic year only and further
yearly allotments will depend on satisfactory academic performance and discipline
➢ I will not involve in any anti-social activities (Lr.No.7172/SA 3/2014 Dated 11.02.2015) in and
out of the hostels & college. If found, I am liable to be expelled from the hostel and college.
(Declaration has to be submitted).
➢ I shall be responsible for the safe custody of the items provided in my room.
➢ I assure that I will bear all liability in case of any damages occurring to the items in the
hostel.
➢ Any valuables things are to be kept securely. The management is not responsible for any
loss/theft of the valuables.
➢ I assure that my son / ward will abide by the Hostel rules and regulations.
Signature of the Student Signature of the Parent / Guardian
Signature of the Warden with date
SRI VENKATESWARA COLLEGE OF ENGINEERING - HOSTEL
UNDERTAKING
I hereby undertake to stay in the college Hostel during my entire period of study
I will not vacate from the hostel in the middle of the program
I shall abide by the hostel rules as in force at point any time
Name of the student:
Room No:
Branch & Year:
Year of admission:
Signature of students Signature of Parent
COPY OF EVIDENCE FRO THE FOLLOWING TO BE ENCLOSED
8. MEDICAL FITNESS CERTIFICATE : ………………………………………………………….
9. PHYSICALLY CHALLENGED : ………………………………………………………….
10. AADHAR NO : ……………………………………………………….
11. PAN No. :………………………………………………………….
12. BANK DETAILS (LIVE) : ……………………………………………………….
SAVINGS BANK ACCOUNT NUMBER : ……………………………………………………….
IFS CODE : ………………………………………………………..
NAME OF THE BANK : …………………………………………………………
BRANCH : …………………………………………………………
