AWWA WOMENS HOSTEL, RAO TULA RAM MARG NEW DELHI

Registration No. Telephone R.V. No. : : Hostel : 26149408 Manager Administrator Military : 39808 and 39465 Phone : 26145294 Fax : 26141665 REGISTRATION FORM FOR HOSTEL ACCOMMODATION (APPLICABLE FOR ONE SESSION ONLY) Particulars of payment of Registration Fees... DD No. .... Date .. Bank on Which the DD is drawn Amount Rs. ... R.V.No. ... Application received on . Receipts/Payment Rs. Security . Annual Charges Admission Fee .. Hostel Dues From To passport size photo of the applicant (Ensure submission of three more passport size photograph for issue of an identity card) TOTAL Dated .. R.V.No. .. (Physicallyreported). Manager To The Manager Administrator AWWA Womens Hostel Rao Tula Ram Marg, Shanker Vihar Road, Opp. Signals Enclave, Delhi Cantt 110010 Dear Sir, Please Register my name for accommodation in the AWWA Womens Hostel. The relevant particulars are given below :1. Name of the Applicant .. (In Block Letter) 2. 3. 4. Date of Birth ... Accommodation Required form ...To Particulars of the Father .................................................................................................................... (a) (b) Service No. Rank & Name . Unit posted to with Present Address & Tele No. (c) (d) (e) Residential Address & Tele No. ...................................................................................... Date of Birth ... Permanent Home Town and Address . .

(f) CDA A/C No./PAO. .. 5. Name, Address and occupation of local Guardian (s) (a) (b) (c) Name.. Occupation. Office Address........................................................................... Tele..... (d) Residential.............................................. Tele..... 6. Course of Study of the Applicant (a) Name of the Institution ... .. (b) (c) Approximate Date when the course is excepted to be completed... Roll No. of the Candidate of College .. (in case of No. attatch a certificate stating so) 7. Education Qualification..... 8. Any other information (Please feel free to give here any information which in you opinion will help us understand the applicant better) 9. Following documents are enclosed : (a) Affidavit by the parents on non Judicial Paper duly attested by Notary (b) Declaration by the Local Guardian (s) as per format attached. (c) Medical fitness Certificate & Immunisation Certificate. (d) 3 Copies of Photographs of the applicant duly attested. (e) Dependency Certificate authorising treatment in military Hospitals. (Appx to A) 120/80A). (f) Proof of admission in Delhi (Photostat copy Identity card & fee deposit receipt) (g) Copy of posting order (in case posted out from Delhi). (h) Specimen signature of all approved visitors are required on plain paper, Not more than 5 persons hall be allowed as approved visitors.

CLARATION (AWWA WOMENS HOSTEL RESIDENT) (a) I declare that I have read all the rules, regulation, norms, code of conduct, responsibilities of inmates and procedures for & to be followed by the inmates and the local order given from time to time as constituted under para 1 to 78 of AWWA Hostel Delhi Cantt, & agree to accept and abide by them. I further declare that on admission I shall submit to the disciplinary jurisdiction of the Warden/Manager AWWA Womens Hostel and other authorities who may be vested with the charge of exercising discipline, under regulation constituted under para 1 to 74 of info brochure and local order issued time to time. (b) I also declare that particulars given above are correct to the best of my knowledge. (c) I also declare that I will attend the college/professional course only and will not take up the job during my stay in the hostel. (d) Any misdemeanor with the managerial staff on the part of myself or LGs/Parents inside the hostel premises will make me liable for withdrawal. (e) No late night are permitted. (Signature of Applicants) COUNTERSIGNED __________________ Signature of the Father Date ____ ___________ Place ______________ __________________ Signature of the Mother Date ______________ Place _____________ Note : 1. The registration is valid for one academic session for which details is given in para 3 of the form i.e. Accommodation required From ____________________________ To_________________________ 2. Residents will inform in writing to the Manager 04 + months clear in advance, the date of finishing of FINAL exams as indicated in para 6 of this form. Finally leave the hostel with her belongings NOT TO RETURN. Extension for stay in the hostel will NOT be given for further studies/traineeship etc. other then the time mentioned in the application form. Final year students & post graduated & other courses will clear their dues and leave the hostel with baggage NOT TO RETURN. DECLARATION BY THE LOCAL GUARDIAN AFFIX PHOTOGRAPH 1. I . complete postal address .. . . hereby agree to be local guardian for Ms .... Student of . daughter of No .. Rank .. Name .. 2. I hereby solemnly further declare that I have read all the rules, regulations, procedure, norms & responsibility

for & be followed by hostel resident contained in the prospectus of AWWA Womens Hostel constitute under para 1 to 76 & the local order given from time to time while her stay in the hostel and take full responsibility to monitor the child activities. 3. I also undertake, in the absence of the parents, the responsibility of taking child for medical treatment as & when required, the withdrawal of the child due to disciplinary grounds/violation of rules, or any major sickness. 4. I agree that late night not permitted. Signature of Parents Date : ____________ Place : ____________ Signature of Local Guardian Date : ____________________ Place : ____________________ Tele No Office _____________ Tele No Resi _ ______________ FORM OF AFFIDAVIT I S/O Shri . ... .... resident of . . do hereby solemnly affirm and declare as under :1. That I have read and understood the prospectus rules, regulation, norms, code of conduct, responsibility of inmate and procedure for & to be followed by the inmates and the local order given from time to tome as constitute under para 1 to 76 of AWWA Hostel Womens Hostel brochure, Rao Tula Ram Marg, Delhi Cantt. I guarantee & promises that my daughter Miss . will abide by the rules procedure, norms stated therein. I further undertake the payment of all dues by dates specified from time to time. I am aware that late nights are not permitted. DEPONENT VERIFICATION Verified at on this date the contents/statements of this affidavit are true to my knowledge and belief. ATTESTED NOTARY UNDERTAKING TAKING OVER ROOM & COMMON AREA ITEMS/INVENTORY 1. I --------------------------------- occupant of Room No --- of -------------------------Block has taken over my room at AWWA Womens Hostel for the session 20072008 (01 Jul 2007 to 31 May 2008). I have checked all my furniture items issued to me for my individual use and found them correct and in serviceable conditions & there is no discrepancy whatsoever. I have checked all electric points for my individual use and found serviceable & correct. I also understand clearly that I am also responsible for proper use & upkeep of common use items like mirror, dust bin, other electric points, room coolers, chicks, electric press table & cloth, fans, bathroom geyser & other sanitary fitments in my room & common area of responsibility. I have read these rules in para 1 to 3 above in conjunction with Hostel rules & regulations as in para 1 to 76 of hostel brochure/regulation. Any unfair wear & tear, misuse

of items in contravention of above rules and damage due to neglect/misuse/unauth items use, will be paid by me in cash as evaluated by hostel adm office. The damage cost alternatively may be deducted from my security money deposited with AWWA Womens Hostel. 2. 3. 4. 5. ( ) Signature of Parents/LGs Date : ( ) Signature of the applicant Date :