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Netaji Subhas University of Technology Azad Hind Fauj Marg, Sector - 3 DWARKA, NEW DELHI-110078 Bh-Iii Hostel Hostel Requisition Form
Netaji Subhas University of Technology Azad Hind Fauj Marg, Sector - 3 DWARKA, NEW DELHI-110078 Bh-Iii Hostel Hostel Requisition Form
Netaji Subhas University of Technology Azad Hind Fauj Marg, Sector - 3 DWARKA, NEW DELHI-110078 Bh-Iii Hostel Hostel Requisition Form
BH-III HOSTEL
HOSTEL REQUISITION FORM
YEAR 2016
SEMESTER 7
Acknowledgement Slip
(Signature of Warden)
NETAJI SUBHAS UNIVERSITY OF TECHNOLOGY
AZAD HIND FAUJ MARG, SECTOR - 3
DWARKA, NEW DELHI-110078
BH-III HOSTEL
STUDENT RECORD FORM
(To be submitted at the time of Hostel admission)
1. NAME RISHABH SRIVASTAV
7. SEMESTER 7
9. BLOOD GROUP A+
12.ADDRESS
Communication Address Permanent Address LOCAL GUARDIAN
Flat No.5211, ATS Dolce, Plot No. GH-12A, Flat No.5211, ATS Dolce, Plot No. GH-12A,
SECTOR-ZETA-01, GREATER NOIDA, SECTOR-ZETA-01, GREATER NOIDA,
GAUTAM BUDDHA NAGAR GAUTAM BUDDHA NAGAR,
UTTAR PRADESH, INDIA, Pin: 201301 UTTAR PRADESH, INDIA, Pin:
13. Mention any chronic illness/medical problem that may need urgent medical attention
NIL
We hereby state that all the information given above is true to the best of our knowledge.
SIGNATURE OF STUDENT
SIGNATURE OF LOCAL GUARDIAN SIGNATURE OF PARENT
UNDERTAKING
I, RISHABH SRIVASTAV SON/DAUGHTER/Ward of Mr/Mrs PREM SHANKAR SRIVASTAVA Roll.No 2016UIC3085
Room No BH-III/A/4/405/B1 hereby give an undertaking that
1. I understand that the institute will not be responsible for any mishappening outside the institute premises.
2. I understand that I will take care of my belongings and the institute will not be responsible for any theft in my
hostel room.
3. I have received a copy of the hostel rules and will abide by them.
4. I have been allotted present room for current academic year only and will vacate it at the end of this academic
year as per the norms of inistitute.
5. I am aware that the hostel fee paid by me will not be refunded after confirmation of the room alloted to me.
6. I am also aware of the fact that at any stage, if I am found violating the above undertaking, the hostel authorities
of NSUT, New Delhi may take suitable action that includes cancellation of hostel accommodation with immediate
effect and even expelling me from the institute.
(Signature of Student)
NETAJI SUBHAS UNIVERSITY OF TECHNOLOGY
AZAD HIND FAUJ MARG, SECTOR - 3
DWARKA,NEW DELHI-110078
BH-III HOSTEL
STUDENT RECORD FORM (DUPLICATE)
(To be submitted at the time of Hostel admission)
7. YEAR 2016
8. SEMESTER 7
9. DATE OF JOINING
............/.........../2016
13.ADDRESS
Communication Address Permanent Address Local Guardian
Flat No.5211, ATS Dolce, Plot No. GH-12A, Flat No.5211, ATS Dolce, Plot No. GH-12A,
SECTOR-ZETA-01, GREATER NOIDA, SECTOR-ZETA-01, GREATER NOIDA,
GAUTAM BUDDHA NAGAR GAUTAM BUDDHA NAGAR,
UTTAR PRADESH, INDIA, Pin: 201301 UTTAR PRADESH, INDIA, Pin:
14. Mention any chronic illness/medical problem that may need urgent medical attention
We hereby state that all the information given above is true to the best of our knowledge.
SIGNATURE OF STUDENT
SIGNATURE OF LOCAL GUARDIAN SIGNATURE OF PARENT
NETAJI SUBHAS UNIVERSITY OF TECHNOLOGY
AZAD HIND FAUJ MARG, SECTOR - 3
DWARKA, NEW DELHI-110078
BH-III HOSTEL
CONTACT No 9953482523
Dramatics
(Signature of Student)