SILCHAR POLYTECHNIC::: MEHERPUR:::CACHAR:::ASSAM
HOSTEL ADMISSION FORM
To
The Principal,
Silchar Polytechnic, Meherpur,
Cacahr, Assam.
Sub :::: PRAYER FOR HOSTEL ADMISSION.
Sir,
I beg most humbly and respectfully to apply for admission in to the Silchar Polytechnic Hostel. I am furnishing below the necessary particulars for your kind consideration.
Signature of the student.
Semester:- Roll No:-
PARTICULARS OF THE STUDENT
(Particulars must properly filled in by the candidate has own hand writing. Forms not found completed in all respect will summarily be rejected.)
1. Name (in block capitals) :
2. Fathers Name :
3. (a) Term:- (b) Branch :- (c) Roll No:-
4. Permanent address :
(The Boarder will have to inform the Hostel
Supdt. Any change in address of communication
Of their guardian whenever occurs).
5.Contact No (a) Student :- (b) Guardian :-
6.Guardians Name( In block capital) :
7.Name of the last Examination result of :
which has been obtained.
8.(a) Weather pass in all subjects :
(b)If yes (i)Percentage of marks secured :
(ii)Total marks secured :
(c)Last examination Roll No :
9.Annual income of parents/Guardian :
10.Whether the candidate belongs to SC,ST(H),
ST(P),OBC, MOBC etc. :
Enclo:- 1. HSLC Mark sheet Signature of the student.
2. Cast Certificate.
Semester:- Roll No:-
I have gone through the Hostel Rules and declared that if I am admitted to Hostel I shall abide by the rules & the discipline of the Hostel. I shall pay the mess dues and other hostel dues regularly failing which I shall be liable to accept any disciplinary action enforced me the authority.
Signature of the student.
Semester:- Roll No:-
NB:-All the Year loss & Discollegiate students should have to vacate the hostel immediately after notified by the Prinipal , Silchar Polytechnic.
HOSTEL ADMISSION COMMITTEE’S COMMENT
Recommended for admission in to Hostel No :-……………..
1………………………………………………………
(Signature of Chairman.)
Admission allowed.
2……………………………………………………..
(Signature of Member.)
Principal,
Silchar Polytechnic, Meherpur. 3……………………………………………………..
(Signature of Member)
HOSTEL FEES TO BE PAID TO HOSTEL SUPERENTDENT OF THE RESPECTIVE HOSTEL IN CASH
1. Rs.5000.00(Probable mess dues ) (Refundable)
2. Rs. 300.00(Caution money) (Refundable).
3. Rs.1500.00(Current mess dues in advance)(Non refundable)
4. Rs. 30.00(Enrolment charge)(Non refundable)
5. Rs 600.00(Hostel Establishment charge per year)(Non refundable).
Total Rs.7430.00 (Rupees Seven thousand, four hundred & thirty) only.
Received in Cash.
Hostel Supdt.
Hostel No:- , SPT.
Principal’s order
Please collect necessary fees from the applicant for admission in the Hostel.
Principal,
Silchar Polytechnic, Meherpur
HOSTEL FEES TO BE PAID TO CASHIER, SPT.
Hostel seat rent per annum – Rs.360.00 (Rupees three hundred and sixty only).
Cashier,
Silchar Polytechnic.
Alloted Room No…………………… in Hostel No…………,Silchar Polytechnic, Meherpur on……………………
Hostel Supdt.
Hostel No:- , SPT.
DECLARATION BY THE STUDENT
I Sri/Smti………………………………………………………………………………. class Roll No……………………………………….
Of ……..semester and boarder of Hostel No……..solemnly declare that:-
1.I do hereby affirm that under no circumstances I shall involved myself directly or indirectly in any kind of untoward activities.
2.I do assure that I shall stay in the hostel only during the period of Examination and I shall not absent myself from appearing the examination. I shall leave the hostel as soon as my examination is over.
3.In violation of any of the above terms I shall be bound to leave the hostel within an hour’s notice.
4.I do understand that this is in addition to the norms, rules and regulations of the hostel.
Signature of the student.
Mobile No:-
DECLARATION BY THE PARENTS/GUARDIAN.
I do hereby state that, I Mr./Mrs.…………………………………………………………………………………………………………………
Aware of Hostel rules & declare that I take full responsibility for any sort of misconduct and financial irregularities indulged in my ward during his studentship in this Polytechnic
ADDRESS FOR COMMUNICATION.
Signature of parents/Guardian.
Village / Town :-
Post Office :-
District :-
Police Station :-
State :-
Mobile No. :-
e-mail :-
.PP.