Rajkiya Engineering College, Sonbhadra – 231 206

Hostel Allotment Form (2021-2022)

(To be filled by office)

Hostel Name:

Allotted Room No.:

Photograph
Signature of Warden

(To be filled by the Applicant)

1. Name of the Candidate ……………………………………… ………………………….............................

2. Father’s Name: ..............................................................................................................................................

3. Roll No./Enrolment No. …............................…………………………………………………………..

4. Branch and Semester….…………………………............................……………………………………….

5. Date and Place of Birth ……………….……………………………………………………………………

6. Category………………..................................…………………………………… (SC/ST/OBC/General)

7. Belonging State and Domicile State …..…………………………………………………………………..

8. Year of Joining the Institute ….………..…………………………………………………………………..

9. Permanent Address …....................................................................................……………………………….

……………………………………………………………………………….............………………………

10. Address for Correspondence …………………………………………………………….................……….

………………………………………………………………………………………………………………

11. Name, Address and Telephone No. of Local Guardian (if any) ..……………….............…................….....

………………………………………………………………………………………………….....................

12. Parent/Guardian Contact Nos. 1................................................... 2. ...................................................

E-mail ID .....................................................................................

13. Name of the Hostel of Last Year and Room No. .........................................................................................

14. Details of any disciplinary action taken against you: (Yes/No)

(If yes): Year - Semester - Punishment - Fine (if any) -

UNDERTAKING
I ……………………………………………….. S/o……………………………………………………. give an
undertaking that no damage would be caused to electrical fittings/furniture/hostel commodities by me or any of
my visitors /guests. In default, I would pay the present actual cost of the article and the fine/punishment as
deemed reasonable by the hostel administration.
I understand that room allotment is final and interchange of room without the permission of
WARDEN is an offence. In default, I am liable to be asked for disciplinary action including vacation of hostel
for one year/forever and /or fine imposed by the college.

Signature of Student