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Hostel Application Form 2024

This document is an application form for admission to the PSG Tech Hostel in Coimbatore, requiring personal details such as name, course, date of birth, and parental information. It includes a declaration of adherence to hostel rules and regulations, along with a note on the non-refundable nature of establishment charges. Applicants must also submit photographs as part of the application process.

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mohankumar8610617365
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17 views4 pages

Hostel Application Form 2024

This document is an application form for admission to the PSG Tech Hostel in Coimbatore, requiring personal details such as name, course, date of birth, and parental information. It includes a declaration of adherence to hostel rules and regulations, along with a note on the non-refundable nature of establishment charges. Applicants must also submit photographs as part of the application process.

Uploaded by

mohankumar8610617365
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PSG TECH HOSTEL

PEELAMEDU, COI MB ATORE - 641 004 Roll No. :


PH. : 0422 4304999, 2572077
SMS GATE WAY : 99422 44421
19 51
APPLICATION FOR ADMISSION
1. Name (in Block Letters) :

2. Course with Branch :

3. Date of Birth : Affix


Passport Size
4. Sex : Male / Female Photograph
5. Religion :

6. Community (Specify) : FC BC MBC SC/ST OC

7. a. Name of the Parent / Guardian :


b. Occupation : c. Annual Income Rs. d. Blood Group :
e. Allergies, if any : f. Cell No. of the Student

8. Residential address or Address for 9.Name and Address of the close relative or
communication (in Block Letters) Guardian in Coimbatore

Off. : Off. :
Resi. : Resi. :
Pin : Cell : Pin : Cell :
E-mail : E-mail :

I, .......................................................................................... having read the Hostel Rules and Regulations


attached, agree to abide by them.

Signature of the applicant

I hereby declare that my son / daughter / ward .......................................................................................................


will strictly observe the rules and regulations of the hostel and I will pay the hostel fees before the specified
date.

v¬ kf¬ / kf´ / v¬ ghJfh¥¾Y´s .........................................................................................................................


ÉL½Æ¬ v±yh ɽKiwfisí« jtwhk± fil¥¾o¥gj¦F«/ ÉL½¡ f£lz§fis F¿¥¾£l nj½¡F´ jtwhk±
brY¤Jtj¦F« ,j¬ ‚y« eh¬ cW½ mË¡»nw¬.

Signature of the Parent / Guardian


bg¦nwh® / ghJfhty® ifbah¥g«
For OFFICE USE ONLY

Admitted on : Room allotted : Warden

Note :
1. The establishment charges, once paid will not be refunded.
2. Application should be complete in all respects.
3. Two passport size photographs and One stamp size photograph should be submitted along with this application.

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