Hostel Vacating Form

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Vacating Room Application

Date: _____________
To,
Hostel Warden
DA-IICT, Gandhinagar.
Dear Sir,
I, ______________________, Id: _______________ am staying in Room No.________. As I completed my ____________
course here, Hence I would like to vacate my room on Date ___________________.

Name with Signature

Particular
Main Door Key with Lock
Table Keys
Wardrobe Key/Latch
Curtain with Pipe
Cot
Chairs (Pl/Iron/Rev)
Window with glass
Door, Latch, Louvers
Book Shelves

Number
1
2
1
2
2
2
common
common
4 each side

Received

Remarks

Dues: Electricity Charges =

Less : Ad Hoc Elec. Paid =


Add : Common Damages =
---------------------Total Dues =

Hostel Wardens Signature

Hostel Supervisors Signature

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