 HOSTELITE FORM

 Capital Words Only.

1. Full Name of the Student: ___________________________________

2. Father’s Name: ___________________________________

Photograph
3. Mother’s Name: _______________________________
4. Date of Birth: ______________________________

5. Mobile number: (Student) __________________________________

(Father) __________________________________

(Mother) __________________________________

6. Permanent Home-town address:

__________________________________________________________________

____________________________________________________________________

Phone No.:___________________________ Pin Code: ___________________

7. Full Name & address of Local guardian/relative in Vadodara:

___________________________________________________________________________

___________________________________________________________________________

Phone No.:__________________________________ Relationship: ________________

8. Persons to be contacted in case of emergency:

A. ____________________________Phone No. ________________________

B. ____________________________Phone No. ________________________

10 Stream:- General/EWS/OBC/S.C/S.T/Other/NRI Quota.

11. Hostel Room No._____________________________.

1
12. Year of Study in College.

Batch Year.______________________________________

Batch Name: _____________________________________

13. Vehicle Number No. _______________________________(Two Wheeler)

14. Vehicle Number No. _______________________________(Four Wheeler)

15. Name of Electric Equipment.

1…………………………. 2………………………… 3…………………………

4…………………………. 5………………………… 6………………………...

16. Furniture allotted from hostel.

1. Table…………….. 2. Chair…………

3. Bed……………….. 4. Other Item……............

. “I hereby certify that the above mentioned information has

been filled by me and I shall be fully responsible/guilty for any
legal action taken by the organization if the information is found
to be incorrect”.

……………. ........................................
Date Signature of student.

…………………………………….

Warden,
Gmers Medical College,
Gotri, Vadodara

Documents to be attached:
1. Photocopy of GMERS Medical College appointment letter.
2. Latest Hostel fees Paid Receipt Copy.
3. Id Proof: Photocopy of Aadhar card.
4. Photo copy Driving License.(If Have Vehicle)
5. Gmers Medical College ID card Copy.