VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY,NAGPUR-4440 010

Admission Form for Hostel Admision    Session 2017-18

UG

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) JEE5647          
Class : Bachelor of Technology   Sem : I Branch : B.Tech. IN COMPUTER SCIENCE & ENGINEERING
Yr. of entry in the Inst.: 2025
Student Name  :  ...THORAT MRUNAL MILIND....
Father's Name  :  ...Milind Thorat....
Sex : Female Married : Y/N.........Blood Group :....B RH +......Date of Birth :...18/11/2006.....
E-mail : mrunalthorat8121@gmail.com................
Mobile No. : 7776003636.................................
Fathers Full Name : Milind Thorat.........................
Complete Residential Address : Near Ambazari Garden.............................. STD Code : ..............................................................
Near Ambazari Garden.............................. Phone 1 : 09623143636......
.............................................................................................................................................................................. Phone 2 : 7776003636......
.................................................................................................................................................... Fax : .........................................................................
City : Nagpur......
District : Nagpur...... PIN Code : 440033......
State : Maharashtra............
E-mail of Father : milind.thorat75@gmail.com............
Income of Father : Rs...200000............ (p.a.)

(Signature of Student)

 

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


Father's Office : At home............ STD Code : ..............................................................
0............ Phone 1 : 9623143636............
.............................................................................................................................................................................. Phone 2 : 7776003636............
Designation : 0............ Fax : ...........................................................................
City : Nagpur............
District : ............ PIN Code : 0............
State : Maharashtra............



Name of Guardian : Milind Thorat............ Mobile : 09623143636............
Address : Near Ambazari Garden............ Mobile : 7776003636............
Purohit Layout PIN Code : 440033............

Name and Contact number of two relatives

1) Name : KUNAL JATKAR............ Mobile : 9922148587............
2) Name : Ashok Markad............ Mobile : 9922678240............

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

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, ..THORAT MRUNAL MILIND........... student of ........................................... semester B.Tech./ B.Arch., 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)