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Motilal Nehru National Institute of Technology Allahabad, Prayagraj
Hostel Admission Form (2025-26)
Name of Hostel: Room No. Allotted:
Mess fee details: Bank : DD No. / TXN ID : Date: Photograph
Signature of Signature of Signature of
Accountant Care Taker Warden
(To be filled by the Applicant)
1. Name of the Candidate (in Capital letter as per Institute record).......................................................... .... ...............
2. Registration No...................... .............. Date of Birth….... .... .... .... .... .... .... Blood Group..... .. .... .... .... .... ....
3. Program, Semester & Branch................................................. ...................................................................................
4. Year of Joining the Institute ....................................................... ..... ..... ..... ..... ..... ..... ..... ..... ...... ..... ..... ..... .....
5. Mobile No......................................... ...... Email ID .................................................................................................
6. Aadhar No......................................................................................................... ..... ..... ..... ..... ..... .......................
7. Bank A/c No.................................................IFSC code.................................Bank Name.... ..... ..... ..... .................
8. Belonging State and Domicile State........................................................................................... ..... ..... ..... ..... ......
9. Country and Nationality.............................................................................................................................................
10. Name and Address of Parent/Guardian……………………………………………………………………………
.....................................................................................................................................................................................
............................... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... .....
11. Permanent Address for Correspondence ..... ..... ..... ..... ..... .................................. ..... ........................................
............................................................................................................................................................. ..... ..... ..... .....
12. Nearest local guardian details:
Name..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... .....,…………………………………..
Address..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... .....
..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... .....
Telephone/ Mobile No. ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... .....
13. Name, Registration No. and Address of any Senior Student of the Institute known to you ..... ..... ..... ..... ..... .....
.......... ..... ..... ..... ..... ...................................................................................................... ..... ..... ..... ..... ..... ..... .....
..... ..... ..... ..... ...........................................................................................................................................................
14. Father/Guardian contact details (Phone (O) (R) (Mob.)
(E-mail)
15. Railway Station Nearest to Place of Residence.............................................................................. ..... ..... ..... ..... ..
16. Name of the Hostel of Last Year and Room No............................................................................. ..... ..... ........ .....
17. Category (UR/SC/ST/OBC/ /General EWS) ........................... ........................... ........................... ................ .........
18. Details of any disciplinary action taken in your last stay in Institute: (Yes/No)
(If yes): Year Semester Punishment Fine
This is to certify that all the entries made by me are correct and as per record. I assure you that I will abide by the
hostel rules and never indulge in any act of indiscipline. Further I will not involve myself in any kind of ragging of
activities. If found involved in ragging, I may be expelled from the hostel ‘and Institute.
Signature of the Student
UNDERTAKING
DETAILS OF INVENTORY ISSUED TO THE STUDENT
I have received the following furniture and fixture in my room at the time of allotment. I shall be responsible
for any loss/damage and I will handover these items before leaving the hostel room.
S. No. Items Qty Remarks
1 Fan
2 Switch
3 LED/ Tube
4 Socket
5 Cot
6 Table
7 Chair
8 Almirah
9 Reading lamp
10 Internet port
11 White wash in room Nil Yes/No
I…………………………………………………………S/o………………………………………………………
give an undertaking that no damage would be caused to electrical fitting or furniture by me or any of my
visitors/guests. In default, I would pay the present actual cost of the article and the fine as deemed reasonable by the
hostel administration. Failing which, hostel/institute administration may take appropriate action including withheld
of final result/degree. Further, hostel administration can also impose fine during my stay in hostel if any of the above
tabulated items are found in damaged condition during their surprise visit.
I understand that room allotment is final and interchange of room without the permission of CHIEF WARDEN
is an offence. In default I am liable to be asked for disciplinary action including vacation of hostel for one
year/forever and/ or a fine Rs. 2000/-.
Date: Signature of the Student
........................................................................................................................................
(FOR OFFICE USE)
(i) The Student has returned all the Inventory issued to him at the time of leaving the hostel.
(ii) The Student has not returned the complete inventory issued to him and the details of unreturned items are
given below:
1. 2. 3.
4. 5. 6.
Care Taker Warden
