Office of the Chief Warden

National Institute of Technology Jamshedpur

Hostel Allotment Form for Academic Session 2023-24

HOSTEL ALLOTTED
(To be filled up by Office Staff)

Photograph ROOM NO. ALLOTTED

(To be filled up by Office Staff)

1. Name of the Student

2. Registration No. ( Roll No. )
3. Discipline/ Branch / Semester
4. Mobile No. (self)
5. Email ID (Institute)
6. Email ID (Personal)
7. Gender
8. Date of Birth
9. Category / Religion
10. State of Domicile
11. JOSSA/CSAB/CCMT/CCMN/NIMCET
Application No. or admission No.
12. Blood Group
13. Date of admission to the Hostel
14. Bank A/C Details (Personal) Bank Account No. :
IFSC Code :
Name of the Bank :
Branch/Address :
15. Aadhar Card No.
16. PAN Card No.
17. Father’s Name / Mobile No.
18. Mother’s Name / Mobile No.
19. Permanent Address with Contact
no. and Email ID
of Parents / Guardian
Contact No.:
Email ID:
20. Address of the Local Guardian

Mobile No.
Email ID:
21. Name, relationship and mobile no.
of maximum two persons, other
than Parents, authorised to
accompany girl student to
home/outside
22. Full Signature of the student / Date
(Continued)
23. Address of the Local Guardian

Mobile No.:
Email ID:
24. Previous Hostel Allotment 1st Semester:
(Hostel & Room No.) 2nd Semester:
3rd Semester:
4th Semester:
5th Semester:
6th Semester:
7th Semester:
8th Semester:
25. Details of fee paid (semester
wise): Tuition Fee, Hostel Fee
& Mess Fee (Amount, Date and
transaction ID)

26. Semester wise CGPA 1st Sem: , 2nd Sem: ,3rd Sem:
4th Sem: , 5th Sem: ,6th Sem:
7th Sem: , 8th Sem:
27. Extra-Curricular activities,
Positions held, medals,
awards, etc.

28. Undertaking by the student:

I, ……………………………………………………, Registration No……………………
hereby give undertaking that all information furnished by me in this hostel allotment
form is correct and :
1. I will not own any motorized vehicle in the hostel and in the Institute premises.
2. I will not use any prohibited drugs & alcohol and will not own any fire arms,
weapons, unwanted materials in my room, hostel or inside Institute’s premises.
3. I will not indulge in any ragging activities.
4. I will abide by rules and regulations of the hostel and the Institute.
5. I am aware that heavy monetary fine or academic penalty may be imposed
against me and I may be expelled from the hostel or from the Institute if I am
found indulged in any activity violating rules and regulations of the hostel /
Institute. Decision of the hostel/Institute authority in this regard will be binding
upon me.

Signature of the Student Countersigned by the Parents

Date: Date:
29. FOR OFFICE USE ONLY: