GAYATRI GIRLS HOSTEL
GAYATRI VIDYA PARISHAD COLLEGE FOR DEGREE AND PG COURSES (A)
Undertaking To Be Given By All The Students Who Wish To Use Hostel Facility
How to complete the form:
1. Please write in BLOCK LETTERS.
2. One (1) passport-size color photograph.
3. Hostel payments should be made by Cash/Bank Draft.
** Payments other than cash should be made in favor of
Gayatri Hostel, Visakhapatnam.
STUDENT PARTICULARS
Name: _____________________
DOB: ______________________
Photograph
Nationality: _________________ PP
Religion: ____________________
Course Name (Programme): ____________
Mobile No: _____________________
Email: _________________________
Permanent Address: __________________________________________________
____________________________________________________________________
____________________________________________________________________
Postal Code: ___________________
Medical History (if any): _______________________________________________
_____________________________________________________________________
PARENTS PARTICULARS:
Name of Father: _________________
Occupation: _____________________
Name of Mother: __________________
Parents Photos (Passport-Size)
Occupation: ______________________
Mobile No: 1._____________________
2._____________________
Permanent Address: _________________________________________________
____________________________________________________________________
GUARDIAN DETAILS (Local):
Name: _______________________
Photo (Guardian)
Occupation: __________________
Relationship: _________________
Mobile No: ___________________
Address: __________________________________________________________
__________________________________________________________________
RAGGING IS STRICTLY PROHIBITED
As per the Supreme Court judgment in Vishwa Jagriti Mission v. Central Government and Others (2001) 6 SCC
577, AND as per Act of Govt. of AP w.r.t ragging, ragging is a cognizable criminal offence and is strictly
prohibited. If any incident of ragging comes to the notice of the Institution, the concerned student shall be given
liberty to explain and if his explanation is not found satisfactory, the Institution would expel him from the
Institution.
Signature of Parent:…………………………….. Place: ____________________
Signature of Student:…………………………….. Date: _____________________
GENERAL CONDITIONS FOR ACCOMMODATION BOOKING:
1. Rooms are allocated on a first-come-first-serve-basis.
2. All applicants are required to sign a tenancy agreement for a minimum period of one (1)
academic year (12 months).
3. In between you want to vacate the hostel we dint refund your amount.
4. If you want to vacate the hostel intimate at least two months before.
Declaration:
1. I understand and accept the general conditions for booking of hostel accommodation.
2. I declare that the particulars in this application form are true to the best of my knowledge
3. I follow Rules and Regulations of Hostel (i.e follow mess timings, present in hostel
campus on/before 5:00PM).
Signature of Student: ________________ Place: ________________ Date: ____________
UNDERTAKING TO BE SIGNED BY THE PARENT / GUARDIAN
I, ____________________________F/o_____________________do hereby solemnly affirm
and undertake that:
1. My son/daughter/ has submitted this Undertaking for Hostel Facility with full understanding
and my express permission; and I shall hold myself responsible for his/her good conduct and
behaviour as a student of the Gayatri Vidya Parishad College for Degree and PG Courses(A)
and adherence to the Provisions.
2. I shall hold myself responsible for payment of all his/her fee and other charges during his/her
stay in the hostel and pending dues, penalty, etc.
3. I shall, myself, be responsible for any sort of liability arising and any civil or criminal case
lying against my son/daughter/ward during the course of study.
4. I endorse the undertaking given by my son/daughter.
Signature of Father/Mother/Guardian: _______________
Place and Date: _________________________
UNDERTAKING FOR HOSTEL FACILITY BY THE STUDENT
I, _____________________________ D/o ______________________do hereby solemnly affirm
and undertake that:
1. I shall retain the hostel accommodation for the full academic session (i.e. one year) and if due
to any reason I leave the hostel during the academic session (one year), I shall pay the hostel
charges for full academic year.
2. I shall not be entitled to claim my admission to the hostel as a matter of right.
3. I must ensure that the doors are locked and all electrical switches are switched off when not in use.
4. Students are strictly prohibited from admitting strangers or persons of the opposite sex
(mothers/sisters) into the hostel room.
5. I am aware that ragging is a criminal offence and is strictly prohibited. I shall not indulge
directly or indirectly in any act of ragging in the hostel campus. If I indulge in ragging, the
Management may take appropriate disciplinary action against me and further legal action
as per law of land.
6. I shall be liable to pay for any damage caused by me to the property of the hostel either alone
or jointly with others and face disciplinary action.
7. I do not have the tendency, and shall not make any attempt, to commit suicide or abetting or
inciting any other person to commit suicide or anything unwarranted and /or prohibited by
law or otherwise and shall not give any sort of threats to commit suicide or likewise and or
being found guilty of the aforesaid action, I myself shall be responsible for any consequences
under law and the expulsion/rustication from the Institution and any other legal action under
the law of land. The Management shall not be responsible for the same.
8. I am medically fit and have no communicable and serious diseases like that of fits, any sort
of attacks or any other I shall pay for any expenditure incurred by the Institution on my
treatment for any sickness or personal injury due to any reason during the course of my
study at the Institution.
9. I shall not keep excess cash and valuables with in the hostel and in case of any loss or
damage of cash or valuables, including mobile phones, PC, laptop or any other personal
belongings, the Institution or hostel shall not be responsible for any kind of compensation.
10. I will have to vacate the hostel in case of any requirement of the Institution for some specific
period for any reasons including accommodating guests, delegates, participants of any event,
for maintenance work etc.
11. The Management has the full authority for the inspection of the room, bags, almirahs or any
of my personal belongings at any time.
12. I understand that hostel, allotted at the time of admission or otherwise, may be shifted to
other hostel, at any time and the allotted room, floor and other facilities in the hostel may
also be changed at any time, as decided by Hostel Warden.
13. I shall not allow any unauthorized person to enter or stay in my room.
14. I shall myself take precautions against insect-bites, dog-bites, snake-bites, animal-bites,
plant-bites and such other infections and diseases and shall carry the first –aid kits every time
and the Institution shall not be liable for such infections and diseases.
15. I shall not misuse electricity by using electrical gadgets like irons, heaters, audio players,
juicers etc.
16. If I absent myself from the hostel without permission, I am liable for disciplinary action,
which may amount to my rustication/expulsion from the hostel.
17. I am giving this undertaking with full understanding and state that the information given by
me above are true and complete to the best of my knowledge and belief and the information
given by me are genuine and nothing has been concealed / suppressed. I understand that if
any of the statements made by me above is found incorrect, I shall be liable to such
disciplinary action(s) and/ or penalty as may be decided by the Management, notwithstanding
legal action under the law of the land. In such case, the hostel fee and other charges deposited
by me shall be forfeited.
18. Visitors are strictly prohibited from staying overnight
19. Smoking, consumption of alcohol and drugs are strictly prohibited.
Signature of Student: _________________
Place: ___________________
Date: ___________________
