GOVERNMENT COLLEGE OF ART, CHANDIGARH INTERNATIONAL HOSTEL, SECTOR 15-A, CHANDIGARH HOSTEL ADMISSION FORM Class ____________________Roll No._________________Room No Allotted ________ 1. Student’s Name_____________________________ (in capitals) 2. Father’sName_______________________________ (in capitals) 3. Mother’s Name______________________________ (in capitals) PHOTO 4. Date of Birth________________________________ 5. Permanent Address___________________________ ___________________________________________ ________________________________________________________________ 6. Telephone No._______________________(M)__________________________ 7. Nationality ______________________________________________________ 8. (i) Name of the Local Guardian_______________________________________ (ii) Address________________________________________________________ ________________________________________________________ (iii) Telephone No. ________________________(M)_______________________ 9. Whether SC/ST/BC___________________ 10. Have you ever had any serious ailment Yes/ No I solemnly declare that the information given above is correct and nothing relevant has been held back. In case I cease to be a student of the college, I shall inform the warden immediately and vacate the hostel. I have read the hostel rules and shall abide by all the rules, other regulations of the college and the instructions issued from time to time by the warden/principal of the college and shall pay all my hostel dues regularly. Dated: Student’s Signature P.T.O FATHER’S/ GUARDIAN’S DECLARATION I _______________________________father of_____________________________ (father Name) (name of the student) undertake the responsibility for the conduct of my son/ward during his stay in the hostel. The authorities may even expel him from the hostel/college if he does not abide by the rules. I also take the responsibility of paying hostel dues every month. In the interest of my son/ward I shall keep in touch with the warden. Dated: Signature of the Father Warden Principal FOR OFFICE USE ONLY Received Rs. ______________ hostel funds and Rs______________ Hostel Security vide Receipt No.______________ Dated_______________ Cashier College Received Rs. _____________Mess Advance and Rs. ______________Mess Security vide Receipt No. ______________ Dated_______________ Hostel Clerk