Scribd
Upload
482 views1 page

Content://Com - Dropbox.android - fileCache/Filecache/c7090b24 396a 4d2a 870c 56080fc36702

The document is an application for admission and hostel room allotment at the National Institute of Technology Karnataka in Surathkal for student V. Saicharan, a 5th semester Computer Science and Engineering student. It provides details of the student like name, contact information, course details, parent/guardian details, and previous hostel accommodation. The student declares that they have understood the hostel rules and regulations and will be responsible for any damages to the hostel furniture or fixtures.

Uploaded by

KAMALA RATHNAM
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
482 views1 page

Content://Com - Dropbox.android - fileCache/Filecache/c7090b24 396a 4d2a 870c 56080fc36702

The document is an application for admission and hostel room allotment at the National Institute of Technology Karnataka in Surathkal for student V. Saicharan, a 5th semester Computer Science and Engineering student. It provides details of the student like name, contact information, course details, parent/guardian details, and previous hostel accommodation. The student declares that they have understood the hostel rules and regulations and will be responsible for any damages to the hostel furniture or fixtures.

Uploaded by

KAMALA RATHNAM
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA , 2929?

SURATHKAL 1482657689
P.O. SRINIVASNAGAR, MANGALORE
Application for Admission and Allotment of Room in the Hostel

A. STUDENT DETAILS

Name: V.Saicharan

Email: [email protected] Aadhaar No: 5637-1206-7216

Roll Number: 16CO150 Registration Number: 166040

Category (OC/OB/SC/ST): General Whether PwD (Yes/No): No

Computer Science and


Branch: Semester: 5
Engineering

Block Number: Mega Tower II Room Number: B302

Room Type: Single Mess Allotted:

Phone: 8971514770 Course: B Tech

Blood Group: A+ Date of Bir th: 02-06-1998

B. PARENT/ LOCAL GUARDIAN DETAILS:

Name of the Parent: GR Viswanath

Phone Number of the Parent:

Email: [email protected]

Home Address: NO 8, KEMPANNA LAYOUT, RAMCHANDRAURA, BANGALORE- 560 013

Name of the Local Guardian: G R VISWANATH

Phone No. of the Local Guardian:

Local Guardian Address: -

C. OTHER DETAILS:

Whether he was in the hostel last year and if so, whether


he has withdrawn the deposit:

Institute fee paid, receipt number and date:

Hostel fee paid, receipt number and date:

DECLARATION :
I hereby declare that I have pursued and understood the Rules and Regulations of the Hostel and shall abide by
those rules and regulations as also the directions of the hostel authorities.
I hereby under take not to allow any unauthorized persons to stay in my room and in the event of any breach this
condition, I hereby under take lo pay the full damages of this account..
I hereby declare that I am fully responsible of the furniture and fixtures in the room allotted to and under take to
pay the damages to furniture and fixtures.
I hereby agree to get access to mess refund amount using ChangePay. I understand that all remaining amount
will be refunded after graduation by ChangePay.

Place: NITK Surathkal

Date: 10-07-2018 Signature of the Applicant

You might also like