VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY,NAGPUR-4440 010

Admission Form for Hostel Admision    Session 2017-18

PG

FOR OFFICE USE

Recp. No.: ................................. Amount Paid : .............................. Admitted to HB No.: ..................... Room No.: ..........................
Recp. No.: ................................. Amount Paid : ..............................
Date :
Students ID No : .............................. Roll No. : ......................................

(To be filled by the student in CAPITAL LETTERS, Incomplete Forms will not be accepted)

All India Rank (AIR) GATE / JAM0          
Class : Executive Master of Technology   Sem : I Branch : EXECUTIVE M.TECH. IN APPLIED AI AND COMMUNICATIONS-S2
Yr. of entry in the Inst.: 2025
Student Name  :  ...SHIVENDRA KUMAR GAUTAM....
Father's Name  :  ...DEVANSH KUMAR GAUTAM....
Sex : Male Married : Y/N.........Blood Group :....O RH +......Date of Birth :...20/05/1993.....
E-mail : shivendragautam2005@gmail.com................
Mobile No. : 7904204832.................................
Fathers Full Name : DEVANSH KUMAR GAUTAM.........................
Complete Residential Address : PLOT NO.21,8TH CROSS GANDHI SALAI STREET,KAILASH NAGAR KATTUR.............................. STD Code : ..............................................................
PLOT NO.21,8TH CROSS GANDHI SALAI STREET,KAILASH NAGAR KATTUR.............................. Phone 1 : 8448891985......
.............................................................................................................................................................................. Phone 2 : 8821838901......
.................................................................................................................................................... Fax : .........................................................................
City : TRICHY......
District : SATNA...... PIN Code : 485226......
State : TAMILNADU............
E-mail of Father : shivendragautam2005@gmail.com............
Income of Father : Rs...250000............ (p.a.)

(Signature of Student)

 

Students Id No : ..............................................................................................................................................


Father's Office : VILLAGE POST -KOTAR............ STD Code : ..............................................................
VILLAGE POST - KOTAR............ Phone 1 : 9893625971............
.............................................................................................................................................................................. Phone 2 : 9893625971............
Designation : TEACHER............ Fax : ...........................................................................
City : SATNA............
District : ............ PIN Code : 485226............
State : MADHYA PRADESH............



Name of Guardian : SANTOSH DEVI GAUTAM W/O LATE DEVANSH KUMAR GAUTAM............ Mobile : 9893625971............
Address : VILLAGE POST -KOTAR............ Mobile : 9893625971............
VILLAGE POST - KOTAR PIN Code : 485226............

Name and Contact number of two relatives

1) Name : AKANKSHA PANDEY............ Mobile : 8821838901............
2) Name : KAPIL DEV GAUTAM............ Mobile : 8830000474............

DECLARATION BY THE STUDENT

I have read the hostel rules and I do agree to abide by these rules as well as such other rules which are framed by the Institute from time to time. I will not involve in any activities related to ragging or indiscipline. I also undertake to pay the hostel dues in time. I hereby solemnly and sincerely affirm that the statements made and the information furnished above is true to the best of my knowledge & belief. If any of the information furnished therein found to be incorrect or false, I undersigned will be responsible for any consequences arising out of incorrect or false information furnished in the application.


Date:

Place : Nagpur

(Signature of Student)




(Signature of Parent)

 




VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY,NAGPUR

Hostel Section

Hostel Allotment Letter for I Sem. M. Tech. / M.Sc. / Ph.D.

    Mr. / Ms. is _SHIVENDRA KUMAR GAUTAM_________________ allotted Room No. _____ in Hostel Block 1 / 2 / 5 (PG Hostel) / HB 10, for the academic sessions 2017-18 and 2018-19.

Details of Payment :

DD No. / Recp. No. : ___________________ Amount: Rs. 65,400/­


Note -

  • Students would be allowed to stay in the rooms allotted to them 2 days before the commencement of classes

  • In case the candidate wants to cancel the hostel admission, he/ she will be required to submit application in the prescribed form available in hostel section.

  • The room once allotted will remain same for 2 yrs. (1st and final year).


Date :

Astt. Registrar (Hostel)






VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY,NAGPUR

Hostel Section

Hostel Allotment Letter for I Sem. M. Tech. / M.Sc. / Ph.D.

    Mr. / Ms. is _SHIVENDRA KUMAR GAUTAM____________________ allotted Room No. _____ in Hostel Block 1 / 2 / 5 (PG Hostel) / HB 10, for the academic sessions 2017-18 and 2018-19.

Details of Payment :

DD No. / Recp. No. : ___________________ Amount: Rs. 65,400/­



Note -

  • Students would be allowed to stay in the rooms allotted to them 2 days before the commencement of classes

  • In case the candidate wants to cancel the hostel admission, he/ she will be required to submit application in the prescribed form available in hostel section.

  • The room once allotted will remain same for 2 yrs. (1st and final year).


Date :

Astt. Registrar (Hostel)



 




VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY,NAGPUR

U N D E R T A K I N G (I)

Students ID No. : ...........................................................................

I understand that:

  1. The students residing in the hostel are not allowed to keep and use motorized vehicles in the hostel. Defaulters shall be Defaulters shall be removed from the hostel.

  2. Consumption and possession of all types of alcohol, cigarettes, narcotics and other drugs would automatically debar the student from residing in the Institute campus.

  3. It is required to maintain the decorum in the hostel premises. Misbehavior with fellow students / hostel staff / warden will lead to rustication from hostel.

  4. Hostel Management reserves the right to allow or not to allow stay of any student in the hostel.

  I shall abide by all the rules and regulations prescribed by the Institute and amended from time to time and cooperate. I shall vacate the hostel room within four days from the last date of examination at the end of even term.



Signature of Parent / Guardian Signature of Student
Name : ............................................................................................................................... Name : ..............................................................................................................................
Contact No. : ..................................................................................................................... Mobile : .............................................................................................................................

Date :


U N D E R T A K I N G (II)

I, ..SHIVENDRA KUMAR GAUTAM........... student of ........................................... semester M.Tech./ Msc. /PHD, Roll No.................................... do hereby solemnly affirm and undertake that I shall not indulge in any form of Ragging and that shall make determine efforts to eradicate ragging totally.

I am fully aware that ragging of junior or other fellow students through physical or mental harassment is a heinous social evil and cognizable offence, that the barbarous act of ragging may disturb the mental balance of the students besides causing physical harm, that this may result into damaging consequence and adversely affect his career permanently and that serious cognizance shall be taken if I am found involved in ragging or of any complaint in this regard which may lead to my rustication from this Institute and also lodging a complaint with the police for taking action against me under the prevailing rules. I am also aware that the use of motorized vehicles is prohibited on the VNIT Campus by hostellers.

Further, I undertake to follow the hostel rules as well as the directives given by hostel administration and I shall be liable for disciplinary action, including expulsion from hostel, if I am found violating the same.

In the event of my in­eligibility to continue in the class for which I have registered, I shall vacate the Hostel immediately.


Date :

Place : Nagpur

(Signature of the Student)