Fresh Student Application For Samras Hostel

Application No:
2214060698 Gujarat Samras Chaatralay Society, Block No : 4/1,
Dr. Jivraj Maheta Bhavan, Gandhinagar - 380 010

To,
I undersigned Vaibhav Naresh Bhai Mendpara want to get admission in Government Samras Hostel for the year
2022. I kindly request to consider my application and confirm my admission. My details given below is true
according to my knowledge and belief.
Personal Details :
1. Name : Vaibhav Naresh Bhai Mendpara
2. Gender : Male
3. Date of Birth : 08/12/2003
4. Aadhar number : ********9154
5. Mobile No : 7990354066
6. Email Address : mendparavaibhav@gmail.com
Yadunandan 22 street no 3 near chandresh nagar Kanya Chatralay
7. Residential Address :
road morbi, Morbi, Morbi - 363641
8. Marital status : Unmarried
9. Family Annual Income (In Rs.) : 99000

Education Details :
10. Further Admission in College : Ahmedabad Institute of Technology
11. Further Admission College District : Ahmedabad
Beside Vasant nagar towm ship 380061, Gota ognaj road of , Gota
12. Further Admission College Address :
cross road ahmedabad gujarat 380061
13. Final Year Student : No
14. Passed Course Name : 12th science
15. Last School/College Name : AshramShala Bhaktashram Eng Med school
16. Last School/College Address: Maneklal Road orange hospital navsari
17. Last Exam Passed Year : 2021

Other Details :
18. Is Disabled : No
19. Type of Disability : NA
20. Percentage of Disability : NA
21. Is Child of Widow : No
22. Is Orphan : No

Details for Samras Admission :

23. Further Course Name : Engineering level Graduation Courses
24. Further Admission Group : Group 1 - Engineering, Pharmacy,etc
25. Further Admission in Hostel : Gujarat Samras Chhatralay Society Ahmedabad Boys Hostel
26. Caste and Sub caste : Other, EBC
27. Result of Last Exam (%) : 70.20

I solemnly declare that if I get admission in the hostel, all the rules and regulation shall be binding to me and
upon breaching of such rules you will have right to cancel my admission at any time without any notice. I will use the
equipment as it's my own and I am binding to pay if any equipments are damaged by me.
This is the application for admission in the hostel but it is not confirmed that your admission is granted in the hostel.

(Signature of Applicant)

Print Date : 11/06/2022 12:48 PM Application No : 2214060698