7esr01g View and Print Hostel Form | Hostel Management by Rahul rn UONORAE Application of Registration for Hostel Accomodation Hostel Registration NO (For Office Use): Name Father Neme Mother Name Date of Birth (Proof to be attached) Semester Session Religion state Nationality Category (Certificate to be attached if not General) Details of the Registration Fee and Hostel Fee remitted by the students (Fee deposited receipt is to be submitted with the form) Programme Department University Registration No, ‘Aadhar No, Whether suffering from any chronic disease? If Yes give @ brief description. (Confirm that copy of medical fitness declaration and certificate is attached with the form) Insurance Policy (The University advises medical insurance to the applicant to meet expenditure against any 210.212.34.22/eup2019Wview_print php Central University of Punjab, Bathinda (Established vide Act no 25(2009) of Parliament) Mr SANDEEP DEVILAL, SHARDA 1998-07-25 Ast 2019-2021 Hindu HARYANA Indian GENERAL M.com. Department of Financial Administration 480373017969 No No M67esr01g View and Print Hostel Form | Hostel Management by Rahul unforeseen health hazard or physical injury or health risk. Failure to fill this column shall not make university liable) Person to be contacted in case of emergency (If on verification the details provided are found to be incorrect, strict disciplinary action shall be taken ) Name DEVILAL Mobile ‘9728067602 Ema devlalruni77@¢mall.com ‘dares village: Rupane Khurd PO: Oarba Kalan Sub Tehsil: Nathusary Cnopta Distret: Sirsa 125110 State: Haryana Local Guardian Mobi Emil Adaress Corresponding Address ares sins state HARYANA Pincoce s2sui0 Permanent Address adsress VILLAGE RUPANA KHURD PO DAREA KALAN TEHSIL AND DISTRICT IRSA incase 25110 ** It shall be mandatory to inform any change in the address or emergency contact number. Failure to do so would not make the University liable for communication in case of emergency ** ** Date of vacating the hostel is as per the Academic Calendar and Hostel Rules. ** Declaration by the Applicant Thereby declare that the information furnished above is true to the best of my knowledge and belief and if admitted, 1 shall abide by the following Hostel Rules and other regulations of the University: 1, The allotment of hostel does not mean arising out of relatonship of lessor and lessee, The student shal be treated mere as a license having the permission to stay in the hostel subject to the obedience of rules, regulations, bye-laws and norms of the University. have read al the rules avalable on the Website and commit myself to obey). I understand that failure to obey the norms er breach of ‘any rule may result into withdrawal of permission by the University, 210.212.34.22/eup2019Wview_print php 2147esr01g 2 View and Print Hostel Form | Hostel Management by Rahul 1 understand the importance of Health Insurance. I have/have not (Yes/No) insured, 1 have also been advised to medically insure myself as a precautionary measure to meet out the expenciture against any unforeseen health hazard, physical injury, risk and treatment thereon. I full understand that the University Rules do not allow any reimbursement the expenditure incurred on the treatment of student. Iam fully aware that failure to mention the insurance policy detail or leaving the respective column blank will neither incur any habllty of the University nor my claim to be reimbursed by the University or the University would spend on my treatment. I will bear the responsiblity of my treatment at my oWn cost. Being a student of institute of National Importance, I assure to observe the norms of decent behavior, modesty in dress sense and discipline, 1 assure that I will not involve myself In any act or cause demeaning the opposite gender, exploitation, harassment, stalking, public display of affection or Indecent behavior. I commit myself to maintain decency, discipline and decorum within 2s well as outsie University as 2 student of this esteemed institute 1 wll not involve myself or participate in any strike, dhamas, protests or any other activity prohibited under Punjab Prevention of Damage to Public and Private Properties Act, 2014 or any other laws in operation. In case of any Involvement, I understand that Iwill be subject te lsciplinary proceedings and legal consequences. 1 assure that my presence and my stay in the University will add to the reputation of the University and I will always contribute in taking this university to the greater heights Thave read the above terms and conditions. I have also read the rules of the Hostel and hereby record my consent without any pressure to abide by the Rules, Regulations and Norms of the University, I assure to comply with all the instructions to be issued from time to time, Station Date: Signature of Applicant Declaration by the Parent/Guardian of the Applicant 1/We certify that my/our ward/applicant has sought admission In CUPB Hostel. We have read and understood all the rules and regulations of the University. We take his guarantee that he will not involve himself in any activity, which Is unlawful or against the Rules. I shall also be liable for all the dues and charges, pending against. the name of my ward Mnf Miss./MP5 sos if he/she leaves the hostel /courses/department of the University. Station Date: Name, Address and Signature of Parent/Guardian Declaration by the Head of the Department This is to certify that Mr/Ms. has been enrolled in the department of 20. for the programme during the session 2019+ 210.212.34.22/eup2019Wview_print php 347esro1g View and Print Hostel Form | Hostel Management by Rahul Station Date: Name and Signature of HOD Chief Warden/DSW Hostel Warden 210.212.34.22/eup2019Wview_print php aa