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Shruti Vasudev Gurav, a female student from Muttur, Bagalkot, Karnataka applied for hostel accommodation on February 4, 2021. She is currently studying the 4th year of BE in Electronics and Communication at a private college in Jamakhandi, Bagalkot. The application details her personal information, family details, college and course details, preferred hostels, and declarations. It also includes verification from her college principal confirming her student details and a verification officer recommending approval of her hostel application.

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Shruti Gurav
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243 views

Print - Application

Shruti Vasudev Gurav, a female student from Muttur, Bagalkot, Karnataka applied for hostel accommodation on February 4, 2021. She is currently studying the 4th year of BE in Electronics and Communication at a private college in Jamakhandi, Bagalkot. The application details her personal information, family details, college and course details, preferred hostels, and declarations. It also includes verification from her college principal confirming her student details and a verification officer recommending approval of her hostel application.

Uploaded by

Shruti Gurav
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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2/4/2021 Print - Application

Government of Karnataka

Department of Backward Classes Welfare


Student Application cum Verification Report for
HOSTEL APPLICATION Fresh 2020-21

1. Application No: 2020 H042 7072 2. Application Date: 04-02-2021 3. Caste Category / Caste: CAT-I / Gurav(Sl.No-16-(a))

4. Student Name : SHRUTI VASUDEV GURAV 5. Gender : Female

6(a). Father Name : VASUDEV 6(b). Mother Name : KAMALAXI

7. Address & Mobile No : MUTTUR ,Jamakhandi , Muttur ,BAGALKOT & 9036519474

9. Pass Year: 2014-Karnataka SSLC


8. SSLC HT No : 20140299741 10. Date of Birth: 07-08-1998
Board
11.Family Annual Income (in Rs.): 20000 12. SATS ID : -NA- 12(a). Ration Card : -NA-

13.College Details(college Nature) : JAIN ACHARYA GUNDHARNANDI MAHARAJ INSTITUTE OF TECHNOLOGY JAMKHANDI BAGALKOT ,
Jamakhandi,Bagalkot , (Private College) ,Visvesvaraya Technological University (VTU), Belgaum
14. Course Name /Course Year /Duration of Course : BE (ELECTORONICS AND COMMUNICATION) / IV Yr / 4 Yrs

15. College Admission No / Admission Date(of this year): 2369 / 29-09-2020 16. Distance (in Kms.) : 18
17. Scholarship Type : Day Scholar 18. Applied for: HOSTEL

19. Bank Name / IFSC Code: CORPORATION BANK /CORP0000415 20. Bank A/c No : 520101214278022

21.Hostel Details : Jamakhandi,Bagalkot. (Hostel Applied Date : 04-02-2021)


22.Income Caste Certificate Details : RD0038618144242 23.Cat.1 Caste Certificate No. : RD0038618144241
A) Preferred Hostel 1 : {HIC Code:1529}JAMAKHANDI--Post--General--Girls Hostel
B) Preferred Hostel 2 : {HIC Code:1530}JAMAKHANDI--Post--General--Girls Hostel
C) Preferred Hostel 3 : {HIC Code:1531}JAMAKHANDI--Post--General--Girls Hostel

I.Declaration
I hereby certify that that above information furnished is true. I have not availed any other hostel for this purpose from any other sources. I shall
abide by the terms and conditions of the sanction of the hostel. If any discrepancies are found later, I hereby abide for refund of the hostel amounts
claimedand also am liable for action by the Department. .

Signature of the Student


Date :

II.Verification Report of College Principal


This is to certify that the information furnished above is verified with the records and found to be correct. He / She is a bonafide student of our
college studying in BE (ELECTORONICS AND COMMUNICATION) / IV Yr (Course & Course Year) during 2020-21 .

Signature of the Principal


Date :
(With College Seal)

III.Verification Report of Verification Officer/


I have verified the contents of Hostel Registration Fresh application with reference to the college records and original certificates, physically
identified the student verified the following certificates

Caste : Yes No Income: Yes No SSLC: Yes No TC: Yes No SATS ID: Ration Card: Yes No
Other Details/Certificates if any:
I recommend for sanction of :
HOSTEL REGISTRATION

I do not recommend the sanction of HOSTEL for the following reasons. (Please specify)

I have physically verified the SSLC Certificate in person

https://karepass.cgg.gov.in/HosPrint.do?type=app&apno=2020H0427072&fresh_renewal=F 1/2
2/4/2021 Print - Application

Date : Signature of the Verification Officer

Print Back
February 4, 2021 05:34:32 PM

https://karepass.cgg.gov.in/HosPrint.do?type=app&apno=2020H0427072&fresh_renewal=F 2/2

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