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Affix latest colour passport size photograph
NATIONAL INSTITUTE OF TECHNOLOGY PATNA
PATNA – 800005, BIHAR (INDIA)
HOSTEL APPLICATION FORM (2016-17) 1.
Name of the Applicant: ………. ……….(In full Block Capital letter)
Mob. No. :……….…………
2.
Roll No.………… Branch ………Semester 3rd5th
7th 9th PG/UG …………
3.
Gender (M/F) :4.
Father’s / Guardian’s Name: ……….Contact No. (With code) ………..….., Mobile No:. ………..
5.
(a). Correspondence Address :……… ………………….………
District:………, Pin code:………, State:…….……...
(b). Permanent Address : ………...
(As per JEE main application) ……….
District:………, Pin code:………, State:…….……...
6.
Category :GE/ SC/ ST/OBC(In case of OBC/SC/ST attach photo copy of JEE main admit card)
7.
Present Hostel accommodation, if any: Name of Hostel:……….… Room No…………...8.
Name and address of local guardians:……….………...……….
Ph. No……….….., Mob. No……….……….…….………..
9.
CGPA (upto last available semester ie. Dec, 2015):(Attach photocopy of Score CGPA )
The above information submitted in this application is true to the best of my knowledge and belief. If any said information is found to be incorrect, I shall be responsible for that. I shall also be abide by the Hostel Management Rules/decision of HMC.
Date:……… (Signature of Student)
*Incomplete application will not be considered for further processing.
****For Office use only**** No.
Received filled application form for hostel accommodation from
Mr./Miss. ……….… Roll No. ………...
Receiving Personal
