Fresh Student Application For Samras Hostel

Application No:
2424191788 Gujarat Samras Chaatralay Society, Block No : 4/1,
Dr. Jivraj Maheta Bhavan, Gandhinagar - 380 010

To,
I undersigned Anjani Nareshkumar Rajgor want to get admission in Government Samras Hostel for the year 2024.
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 : Anjani Nareshkumar Rajgor
2. Gender : Female
3. Date of Birth : 24/11/2002
4. Aadhar number : ************
5. Mobile No : 9265247884
6. Email Address : rajgoranjani3@gmail.com
Gokuldham society, Deesa highway, service road, palanpur,
7. Residential Address :
Palanpur, Banaskantha - 385001
8. Marital status : Unmarried
9. Family Annual Income (In Rs.) : 140000

Education Details :
10. Further Admission in College : St Xaviers College
11. Further Admission College District : Ahmedabad
12. Further Admission College Address : Surajmal Zaveri Rd, Navrangpura, Ahmedabad, Gujarat 380009
13. Final Year Student : No
14. Passed Course Name : B.A. B.Ed. integrated
15. Last School/College Name : Indian institute of teacher education
Near KH-5, 5, KH Rd, near KH, Sector 15, Gandhinagar, Gujarat
16. Last School/College Address:
382016
17. Last Exam Passed Year : 2024

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 : M.A
24. Further Admission Group : Group 2 - Post Graduate level
25. Further Admission in Hostel : Gujarat Samras Chhatralay Society Ahmedabad Girls Hostel
26. Caste and Sub caste : Other, EBC
27. Result of Last Exam (%) : 84.00

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 : 23/06/2024 07:34 PM Application No : 2424191788