Application No. GEC/533 Admn. No.

534/2014-15
Govt. Engineering College, Thissur - 680009
Application for Admission to Hostel (2017-18)
Men's Hostel

1. Name in Full (in block letters) : AKSHAY MOHAN

(a) Gender : Male
2. Date of Birth : 17-02-1995
3. (a) Home Address : MENATH HOUSE, THANISSERY P O, IRINJALAK-
: UDA, 680701
(b) Phone No. : 9400638181
(c) Distance (in Km.) : 50
4. Relegion and Caste : HINDU,EZHAVA ( OBC )
5. Class in College with Reg. No. : S7 EEE -ETAOEEE015 (534/2014-15)
CGPA/Entrance Rank : 7.14
6. Date from which admission is sought for
7. Diet Required (Veg/Non veg) : Non-Veg
8. Name and Permenant address of parent : MOHANDAS M A, MENATH HOUSE,THANISSERY P -
: O,IRINJALAKUDA,THRISSUR
: Mobile :9446938291
9. Relationship with parent : Guardian
10. Name and address of local guardian : MOHANDAS M A, MENATH HOUSE,THANISSERY P -
: O,IRINJALAKUDA,THRISSUR
: Mobile :9400638181
11. Last stayed : PRIVATE HOSTEL
12. Number of years stayed in hostel : 0 year(s) 0
13. Non-liability : DNA

I promise if admitted to rules, by-laws and orders of the hostel authorities during my stay in the hostel
to help them in the maintenance of good conduct and discipline, to set a good example myself, to pay
my dues and not to leave the hostel unless permitted or directed by the Warden to do so.

Station :

Date : Signature of Student

I undertake to be responsibile for the dues of the above named student and for his fullfilment of the promise

Station :

Date : Signature of Parent of Guardian

Verified Register No, Address and CGPA/RANK with records and found correct.

Staff Advisor Head of Department

Warden Principal