Maharaja Ranjit Singh Punjab Technical University
Hostels
Page 1 of 2
Application for : Boys Hostel No. 01 / 02/ 03 /04 / 05 , Girls Hostel No. 01/ 02
1. Name of Student:………, Program: UG/PG, Branch: ………
2. Father/Mother Name ……….., Occupation:……..……….
3. C. R. No.: ………., Uni R. No……… Year:………, Semester:………… . 4. Permanent address:……….……..
………..……
District:……….………State……..…………..…………Pin………
5. Phone No. : i. Self……….…………..., ii. Father/Mother………..
6. E. Mail address: i. Self………..., ii. Father/Mother………..
7. Category: Gen / SC / ST / OBC / EWS / PWD / OMC /………..….
8. Previous pending dues (if any): Rs.……….
9. Detail of Marks:
Semester Max. Marks Marks Obtained Percentage upto 2 digit after the decimal
Remarks ( all clear/reappear) Ist
IInd IIIrd IVth Vth VIth VIIth VIIIth IXth Xth
Declaration:
1. I will follow all the rules & regulations of the hostel. If found guilty of violating the rules, disciplinary action may be taken by the competent authority.
2. I understand the COVID-19 panademic, the risks and SOPs issued by the Govt.from time to time, I will follow all the instructions issued by the Govt. and University from time to time.
3. Certified that the particulars given are correct.
……….
Student Signature
Maharaja Ranjit Singh Punjab Technical University
Hostels
Page 2 of 2 For Girls Students Only
1. Certified that the particulars given by my ward are correct. The following named persons may be permitted to meet my daughter in the Hostel between visiting hours.
Sr No Name Relation Address Specimen
Signature
2. My ward may be permitted to travel by flight/ train / bus services and I hold the full responsibility for the same (Yes / No) :______________
Signature of Parents: _____________________________
Office use only
1. Previous pending dues (if any): Rs.……….
2. Signature of Manager/Warden:
………, ……….., ………., ………. …..………. ………….
GH1 GH2 BH1 BH2 BH3 BH4 Room Number Allotted ____________________
Room Mate, If any:………..
Mess Security Refundable
5000.00 S.W.F.
Non Refundable
700.00 Per Year
M.E.F.
Non-Refundable
300.00 Per Year Receipt No………..Dated………….. Total Amount 6000.00
Warden Manager Care Taker
MRSPTU MRSPTU MRSPTU
Bathinda Bathinda Bathinda
