EXCOGITA-EXCELLENCE IN SCIENCE

Hostel Admission Form

1. Name of the Student: 2. Father’s Name: 3. Mother’s Name: 4. Guardian’s Name:

I have read and understood the Hostel Rules and Regulations and promise to abide by them without any reservation. I understand that I shall not be allowed to leave before April/May of the Competitive year or during the duration of Classroom/Integrated Program nor any refund will be admissible if I leave the Hostel earlier.

Signature of Father/Guardian

Signature of Student

For Official Use

Accommodation Charges: Fooding Charges: Deposited on date: Payment Mode: Date: Signature of Hostel In-charge:

Paste passport size Photo of the student:

Name of the Hostel	Date of Entry	Room Number

Declaration from Parent/Local Guardian

I, Father/Mother/Guardian of , hereby undertake to abide by the above-mentioned rules & regulations of the hostel. I hereby undertake that my SON/DAUGHTER shall not be involved in any illegal/unethical/unprincipled/immoral/corrupt/dishonest activity while his/her stay in the hostel.

I hereby undertake to keep EXCOGITA and Hostel Authorities indemnified in case of any loss that occurs to the name/reputation or pecuniary loss to EXCOGITA/Hostel Authorities or management. Further, I undertake to fulfill all the terms and conditions as mentioned in the Hostel Rules & Regulations. I undertake that EXCOGITA or its Associates shall not be responsible for my SON/DAUGHTER act or conduct which may cause any risk or cause any casualty of any nature whatsoever. My SON/DAUGHTER is joining this hostel after me being aware of all the facilities and formalities. I have read and understood the rules and regulations which have been provided to me.

Signature of Parent/Guardian

Signature of Hosteller/Student

Signature of Hostel Authority