. ' .

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
n.

Class_Branch Mobib irlo. CATEGORY_(S.C/ST/OBC/GEN/PH)

Mother Tongue

Mother's Name

'r5. FathelsName Designation & Organisation

fr

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

sLrl cster

II III

W
VI VU
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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was rcsiding in HostelNo. RoomNo. carctaker on Signature of Mess Supervisor. Warden/ Sr. Warden

Hey' Shehasno mess duesand hashanded over roomto Caretaker

Hostel AllotmentDetrils.
Paid mess'advance Rs...........,....... By DD No"/Challan No. dated.,,.....,..........Name ofBank..,..1..,,...,......,..;,....,......,;..:.,......Branch ............,...... Alloted Hostel No......................Room No....................Signaturc of Mess Supervisor Caretaker._ Warden / Sr. Warden

CQWOffce

Chaimlan, COW

Nnrrornl lrstrrure or TecnuolocY

- 462003(M.P.) BHOPAL BY THEPARENT DECLARATION/ UNDERTAKING

MAULANAAZAD

I hereby undertake to ensure that

1.

prescribed and other in the prospectus My wardshallabideby the rulesand regulations class attendance, requirements, in respect of minimum notification, withregard to fulfilling assignment and studyvisitwhichare essenroomassignments, examination rules,project tial partsof the course structure.
and discipline withinthe class room hosteland camMy wardshall maintaingood behaviour pus. He shall be open to the disciplinary actionfor violationof any of the rules prescribed lherein. My ward shall not damage/deface or spoil the hostel room ( includingthe finishingin the provided by the authorities. rooms)and the furniture& equiprpent

2.

3.

4. 5.

to library books, of damage thatmay be caused Myward shallbe responsible for payment negligence. equipments, computer laboratory etc.through of institute ruleshe will be liablefor punishment I declare that in case my warddisobeys authority. I shallaccept as deemed fit by competent suspension or cancellation of admission authorities. 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. am aware that ragging ragging. hasalsogivendirections against for punishment I furtherdeclarethat if my ward is found to be involvedin any act or indiscipline, I shall acceptthe punishmenUDisciplinaryaction taken by the Instituteauthorities against my ward.
Guardian Signatureof ParenU Name: Address:

6.

Telephone withcode No. Mob.No.

Date:
Place: