8/7/2019 Nizam College - Online application print form

ONLINE APPLICATION FOR ADMISSION IN TO THE NIZAM COLLEGE HOSTELS

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Roll Number - 18-143-1533

Candidate Admitted into the College Nizam College

Subject ID 143

Subject COMMERCE/B.COM(E-COM)

Self Finance No

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1. Full Name (IN BLOCK LETTERS) Bodduna Sai Abhinav

2. a) Father's Name LATE RAJESHAM

b) Mothers's Name VIJAYALAXMI

c) Guardian's Name (Only when both the parents are N/A

not alive)

d) Profession of Father / Gurdian as the case may be FARMER

(If in Service, Designation and Office)

e) Annual Income of Father / Guardian 90000

3. Communication Address :

House No 19-312

Village/Town/City RAMNAGAR

Mandal MANCHERIAL

District MANCHERIAL

4. Permanent (Home) Address :

House No. 19-312

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Village RAMNAGAR

Mandal MANCHERIAL

District MANCHERIAL

State TELANGANA

5. Email : abhinavjaffer@gmail.com

6. Mobile / Phone No. :

Student No. : 9100232600

Parent No. : 9866374608

7. a) Nationality : INDIA

b) State TELANGANA

i) Caste SC ST BC OC / EBC

ii) Sub Caste PADMASHALI

Mess Deposit + Admission Fee Payable is Rs. 4,100 /-

c) Vegetarian / Non-Vegetarian VEG/NON-VEG

8. a)Date of Birth as given in S.S.C/Records of 20/04/2000

Matriculation Certificate (Enter the date accroding to
the Christian Era)

b) SSC HallTicket Number 1535128320

c) Aadhar 789671657388

9. a) Can you pay the Hostel charges every month Yes No

regularly as paying boarder, in time

b) If you have applied for any other scholarship, Yes No

mention the category

10. Are you doing any course simultaneously Yes No

if Yes submit the details.

11.

a. Amount 4611.8

b. Drawn bank STATE BANK OF INDIA

c. SBCollect Drawn Date 07/08/2019

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d. SBCollect Reference Number DUB8579608

12. Whether resident of any University Hostel earlier Yes No

(previous year)

If Yes Give Details

University Name

Hostel Name

Hostel Adm. No

13. Indicate the previous ailments if any along with the O +ve
blood group(Emergencies Optional)

14. To be Signed by Father / Guardian

I agree that the Applicant, who is my son / daughter / ward may be admitted to the
University
hostel. I shall be responsible for the payment of all fees, hostel mess charges and other
charges.
I shall be responsible for his / her conduct and good behaviour while he / she is a Boarder of
the University Hostels

I Certify that the parents of the ward are not alive (for gaurdian only)

Date : Father / Guardian

15 I Promise to abide by the rules and regulations in force of the University hostels.
I furter promise to vacate the hostel during the Terminal holidays and at any time
if
ordered to do so by the Principal / Chief Warden.

I also declare that the statement i have made in this application are correct.

Date : Signature of the Applicant

16 College to which admission has been granted

College Nizam College

Subject ID 143

Subject COMMERCE/B.COM(E-COM)

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College Admission Number 18-143-1533

Head of the Department Vice-Principal (Hostel) Principal

Documents to be enclosed

While submitting printout, the following Documents must be enclosed.

1. DD / Challan – original

2. Copy of the Admit Card / joining report & Orders (for M.Phil & Ph.D)

3. Copy of caste Certificate issued by concerned Mandal Revenue Officer

4. Copy of latest income certificate issued by Mandal Revenue Officer

5. Copies of S.S.C / Inter & Degree Examinations Memos / Certificates

6. Gap Certificate (if any) issued by any Gazetted officer of Govt. of A.P. Stating that he/she has
not studied in any Educational institution and not received any Scholarship.

7. Copy of latest T.C

8. Passport size photos (2 no's)

Note :

1. Hostel Admission will be given the student s belonging to S.C/ S.T/ L.B.C/ E.P.P Categories
only on submission of scholarship form along with necessary Certificates.

2. The E.P.P. Scholarship will be sanctioned to awards given by the Govt. to the University hence
hence is no guarantee for the sanctioning of the scholarship to E.P.P. Boarders.

3. Difference of amount, if any, between scholarship and Mess Charges will not be paid to the
student and will be sent back to the department which sanctioned the scholarship.

4. If the money received as scholarship is less than the actual ammount of money incurred on
Mess and establishment charges, the difference should be paid by each student, every
month.

UNDERTAKING

1 Mr./Ms. _________________________________ S/o. D/o _________________________

Admitted into __________________________ course, Subject __________________ at
Univ. college of ___________________ Osmania University, Hyderabad apply for the Hostel
admission for the Academic Year ______________________

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I hearby give the Undertaking that I will abide by the following rules and
regulations of the University Hostels and Messes.

1. Payment of Hostel & Mess charges regularly.

2. Attending the classes in the respective departments of the college(as per Government
norms.)

3. Not to use Electric Heaters, Stoves, iron Boxes etc., in the Hostel Rooms.

4. Not to allow any Un-authorized persons to stay in the room.

5. Not to misbehave with any Hostel staff or University authority.

6. In case of not getting any financial assistance from any source, I am liable for payment of all
the dues to the University.

7. I promise to maintain the articles provided to me by the Hostel authorities and to return in
proper condition.

8. I will be responsible for any damage to University property caused in the Hostel, and the
amount may be recovered from me.

9. I will vacate the Hostel as per the instructions of the University authorities immediately after
the Academic year i.e. on the last day of the regular examinations.

10. I am aware that the Hostel facility will not be provided for the students writing the Backlog /
improvement / Competitive examinations.

11. I promise to keep the Hostel and premises neat and clean. I will produce my Hostel identity
card as and when required.

Signature

Name of the Student

Course

Subject

PRINT APPLICATION

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