Students Id No : ..............................................................................................................................................
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Father's Office : 1-77, BANDI ATMAKUR............
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STD Code : ..............................................................
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BANDI ATMAKUR............
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Phone 1 : 91............
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Phone 2 : 9989606484............
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Designation : AGRICULTURE............
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Fax : ...........................................................................
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City : NANDYAL............
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District : ............
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PIN Code : 518523............
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State : ANDHRA PRADESH............
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Name of Guardian : ............
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Mobile : ............
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Address : ............
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Mobile : ............
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PIN Code : ............
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Name and Contact number of two relatives
1) Name : REVANTH KUMAR............
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Mobile : 7207073657............
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2) Name : RITESH KUMAR............
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Mobile : 9391540124............
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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)