SGVVT’s

SHREE JAGADGURU GAVISIDDHESHWAR AYURVEDIC MEDICAL COLLEGE & HOSPITAL

KOPPAL-583231
BOYS HOSTEL ADDRESS REGISTER

NAME OF THE STUDENT

DATE OF BIRTH\

FATHER NAME

MOTHER NAME

PRESENT POSTAL
ADDRESS--------------------------------------------------------------------------------------------------------
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PERMANENT POSTAL
ADDRESS--------------------------------------------------------------------------------------------------------
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FATHER PHONE NO:-

MOTHER PHONE NO :-

STUDENT PHONE NO:-

PARENT’s E-mail :- 1.

Hostel Room No:-

Academic Year :-

Date Amount paid Receipt no Hostel Chief Sign