HOSTEL CLEARANCE PERFORMA

(___________Hostels Block________)
Type of Room: _________________
1.

Name: _________________________ S/O / D/O ____________________________

2.

School: ________________________ Email __________________________

3.

Discipline: _______________ Reg# ______________Room No: ________

4.

Date of Joining: _________________________________________________

5.

Date of Leaving: _________________________________________________

6.

Request

security may

be

refunded

after

adjusting

outstanding

__________Hostel dues.
7.

Hostel dues overpaid (if any) may also be refunded.

8.

Cell No: _________________________________________________________

9.

Address: ________________________________________________________

_______________________________________________________________________
10.

Submission of Hostel Card: _____________________________________

_____________________
Signature of Student
FOR OFFICE USE ONLY

11. Dues Cleared Upto:-

12.

a.

Hostels (Fin Dte) ________________________________________

b.

Hostel Security Draft / Slip No. ___________________________

c.

Deferment / Waive Off ___________________________________

d.

Messing Branch _________________________________________

e.

Tuition (Fin Dte) _______________________________________

Barrack Damage if any: _________________________________________

To be paid on deposit slip in A/C # 22927000000401 HBL Sector H-12 Islamabad.

13.

Hostel Card Received:

Yes/ No

14.

Any other remarks: _____________________________________________

_____________________
Signature of Warden