Affix your

latest passport
size photograph
(Self Attested)
COURSE & BRANCH TO WHICH CANDIDATE IS ADMITTED FOR
Faculty Name Name of ProgrammefCourse Duration
PAYMENT DETAILS OF FEE
! have paid the hostel fee with the other fee by making a total payment of Rs. ____________________ made through Cash ReceiptfDemand Draft No.
____________________ Dated _______________ Drawn on ________________________________________________ Branch ___________________
OR
A separate Cash ReceiptfDemand Draft No. ___________________ Dated _______________ of Rs. ____________________ drawn on _______________
_______________________________ Branch _________________ is enclosed towards my hostel fee.
BRIEF HISTORY OF MEDICAL ILLNESS OR ALLERGY (To be filled by Applicant)
ENCLOSURE I - HOSTEL
(This form need to be submited by the candidates who wish
to avail the hostel facility to be provided by the University))
Admission Form Sl. No.
Session
NEWAR
UN!vERS!TY
Gangrar, Chittorgarh, (Rajasthan) 312901
Ph. 01471-220881/2/3/4, Fax: 01471-220886
weos|le : WWW.reWarur|vers|ly.org
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Hostel Preference :
Hostel
Day Boarding
Name
Father's Name
Nother's Name
Gender Date of Birth (DDfNNfYY) f f
Address for
Correspondence
City : State : Pin Code :
Telephone Nos.
8 STD code
Nobile (Self) :
E-mail :
Nobile (Parent) :
PERSONAL INFORMATION
Permanent Address
(!f different from
Correspondence
Address)
City : State : Pin Code :
Nale Female
Name of Person
to be contacted
Address of the
person to be
contacted in
emergency
City : State : Pin Code :
Telephone Nos.
8 STD code
Nobile (Self) :
E-mail :
Nobile (2) :
CONTACT INFORMATION IN CASE OF EMERGENCY
Relation with Candidate
Name of Local Guardian
Address of
Local Guardian
City : State : Pin Code :
Telephone Nos.
8 STD code
Nobile (Self) :
E-mail :
Nobile (2) :
Relation with Candidate
2014-15
Undertaking:
!, the undersigned hereby solemnly affirm and declare that:
1. ! undertake that if ! have been allotted with hostel facility, ! will abide by the provisions of the act, statute, regulations, ordinances and
rules of the University and all other documents or instructions, as framed, amended and enforced from time to time in any form and
manner.
2. The University reserves the right to frame, amend, revoke, repeal and enforce the Rules 8 Regulations, as and when deem fit; and it shall be
my duty to keep myself well versed and updated with the amended Rules 8 Regulations as applicable from time to time; the University shall
not be bound or responsible to intimate me separately in any manner, in this regard.
3. ! understand that the University may provide me hostel facilityfresidential accommodation at its own or through other arrangement, in and
outside campus as it may deem fit.
+. ! agree that ! shall not be entitled for allotment of hostel as a matter of right by submitting this enclosure of the common admission form.
S. ! agree that ! will always co-operate the University by vacating the hostel in case of genuine requirement of the hostel by the University for
some specific period for any reason including but not limited to provide accommodation to guests, delegates, participants of any event or
for maintenance work etc.
6. ! understand that the University has complete authority to inspect my room, bags, cupboards or any of my personal belongings in my
presence or otherwise at any time during my stay at hostel
7. ! understand that hostel, hostel room allotted and various provisions and facilities in the hostel are subject to change from time to time by
the University.
8. ! understand and agree that entrance of the outsiders in the hostel is prohibited and entry andfor stay of my parents and other authorized
visitors is subjected to the permission of warden and other concerned authorities of the University: and if authorities found any
unauthorized person the authorities may take any disciplinary action against me and such unauthorized person and ! would personally
compensate the University for any loss caused to it because the entry of such unauthorized person.
9. ! shall protect myself from against all sorts of insects and animal bitesfattacks and would live hygienically and will keep my room clean and
hygienic and would drink the safe and clean water to avoid infections and diseases. ! declare that the University shall not be liable for any
harm caused to me due to any sort of infections and diseases. However in case of falling sick or any sort of infection, diseases or personal
injury or otherwise, ! shall inform the hostel authority and my parents instantly and shall be liable to pay for all expenditure incurred by the
University andfor hostel authorities on my treatment for any illness or disease or personal injury or otherwise due to any reason during my
stay in hostel.
10. ! shall not misuse electricity by using electrical gazettes like iron, heater, audio players, convector, immersion rod etc.. ! understand that the
hostel fees include the electricity chargesf amount for usage of fixed units and in case the utilized units exceeds the fixed units as decided by
the University ! agree to pay the electricity chargesf amount separately for the extra consumed units. ! understand that the hot water supply
shall be available in winter only for fixed timings.
11. ! agree that ! shall not paste any poster or paintings on the walls of the room or at other places in and outside hostel premises.
12. ! understand and agree that if ! remain absent from hostel without permission, ! am liable for disciplinary action which may go to the extent
of my rusticationfexpulsion from the hostel andfor the University and in such event ! would not be entitled for any refund of feefcharges
paid by me.
13. ! agree that ! shall retain the hostel accommodation for the full academic session and if due to any reason ! leave the hostel during the
academic session (one year) ! shall pay the hostel feesfcharges for the full academic session.
1+. ! agree that if ! declared ineligible for appearing in any examination of the University on account of shortage in attendance or for any other
reason whatsoever, the University authorities may at any time to vacate the hostel immediately. Readmission to the hostel in the forth
coming termfsemester may be allowed at the sole discretion of the University.
1S. !f ! detained during the running of the program due to misconduct or due to any other reason whatsoever, ! shall vacate the hostel
immediately and ! would not be entitled for refund of any feefcharges. Readmission to the hostel in the forth coming termfsemester will not
be allowed.
16. ! understand and agree that hostel fee and related charges are subject to revision from time to time as decided by the University.
17. ! shall be liable to pay for any damage caused by me to the hostel either alone or jointly with others and will face disciplinary action.
18. ! agree that ! may be subject to all possible disciplinary action including but not limited to cancellation of my admission or hostel facility at
any time as decided by the University, if ! have been found guilty of any sort of disobedience of any of the rules and the regulations
notwithstanding legal action under the law of the land and in that case ! shall not be entitled to claim for refund of fees and other amounts
paid unless otherwise decided by the University.
19. !n case ! have been found in possession of any illegal or unauthorized material ! would be subject to the lawof land and would also face the
disciplinary action as set on me by the University. ! would keep the University fully indemnified from all the possible that may occur due to my
illegal and unauthorized action.
20. ! fully understand that ragging is illegal and ! will refrain myself from any such activities that termed as ragging or tantamount to ragging.
Date__________________ Signature of Applicant
Registration No.
Hostel
Remarks
FOR OFFICE USE ONLY
Course Admin No.
Hostel Room No.
Hostel Regd. No.
Bed No.
Signature (Hostel
Committee Nember)