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					    HOSTEL ADMISSION FORM FOR UNDERGRADUATE MEDICAL STUDENT,

                          MEDICAL COLLEGE , BHAVNAGAR




                                                              Photograph
                                                              of the student




Full Name ( in capital letters)    :-_____________________________________

Father's Name                            :-_____________________________________

Date of the birth                  :-_____________________________________

Blood Group ( If you know )              :-_____________________________________

Date of Admission in 1st MBBS      :-_____________________________________

Hostel Admission Block             :-_______________ Room No :-____________

M.B.B.S. 1st /2nd /3rd             :-    Year term I II III IV Receipt No.
                                          ______________________________
( Course .New/Old ) Roll No        :-    1st
                                         _____________________________________________

                                         2nd
                                          ______________________________
                                         Final

Hostel Fee :-______________ Receipt No :-___________ Date :-____________
Deposit :-_______________Receipt No :-___________ Date :-____________

Received following items.
   1)      table ( wooden/ steel )
   2)      chair ( wooden/ steel )
   3)      cupboard ( wooden/ steel )
   4)      Rack
   5)      cot ( steel )
   6)      tube light
   7)      ceiling fan
   8)      show case
   9)      other/ Miscellaneous
Rules and regulations :

     I.        There will be minimum two or three students as per the allotment rules of the
               hostel .
    II.        Hostel room will be allotted to outside student only ( i.e. no admission to
               bhavnagar students).
   III.        Two final M.B.B.S. repeater students will have to stay together in one allotted
               room.
   IV.         Final M.B.B.S. student having more than four trails in final M.B.B.S. examination
               will not be eligible for hostel accommodation.
    V.         Charge of allotted hostel room without written permission of warden/asst. Warden
               by student will result in to cancellation of his/her hostel admission and /or
               disciplinary action decide action decide by the committee.
   VI.         Allotted student / students will be held responsible for allowing non-allotted
               persons to say in his/her/their room and he/she/they are liable for disciplinary
               action for such act.
  VII.         Use of electrical appliances ( heater/air cooler ) or cooking in the room are
               prohibited.
  VIII.        Allotted student in the hostel has to pay deposit and term fee to hostel
               superintendent and to show the receipt as when required deposit is rs. 500/-
               ( five hundred only ).

          Hostel Fee:

            1st    M.B.B.S.                                  Rs.     100 x 2 = 1200
            2nd    M.B.B.S.                                  Rs.     100 x 3 = 1800
            3rd    M.B.B.S.                                  Rs.     100 x 4 = 2000
            Repeater 1st M.B.B.S. and 3rd M.B.B.S.           Rs.                100/-




               Hostel fee is to be paid in stipulated time limit decide by authority – non payment
               of hostel fee in stipulated time limit will result in to fine of rs. 1 (one ) day for one
               month. Even after that if hostel fee has not been paid, hostel admission will be
               cancelled and university form will not be forwarded.

               If hostel deposit of Rs. 500/- has not been deposited in stipulated time limit,
               student has to pay fine of Rs. 5 ( five ) per day

   IX.         If any student/person is collecting money from other students without permission
               Of dean, it will result in to offence, and disciplinary action will be taken on that
               student/person, who is collecting money. His hostel admission will be cancelled
               immediately.
    X.         It is absolutely essential to show the identity card of hostel when asked by
               security officer/hostel superintendent/assistant warden/chief warden. Identity card
               of hostel should be obtained by paying rupees ten (Rs. 10 ) to hostel
               superintendent with two photographs of the candidate.

               if identity card of the hostel is lost the new identity card of hostel will be
               provided with fine of Rs. 25/-
              damage/lose to hostel properties will result in to forfeiting of the hostel deposit of
              student and recovery of damage/lose articles

 XI.          Responsibilities of cash money and valuable articles of students will remain that
              of student himself.
XII.          If any student is harassing other student/students physically of mentally in the
              hostel will be cancelled with immediate effect.
XIII.         Responsibilities of vehicle of hostel students will be of their own. Student will
              be allowed to keep vehicle inside the hostel building. If any vehicle is found
              inside the hostel building, vehicle will be forfeited and disciplinary action will be
              taken .
XIV.          Visitor's hours in the hostel will be from 5.00 to 7.00pm.
XV.           In ladies hostel visitors will not be allowed form 10.00pm to 7.00 am.
XVI.          No students is allowed to go on picnic in person of collectively. First the written
              permission of dean should be obtained and then the warder will allow prior
              permission as must.
              In daily routine, the hostel superintendent's instruction should be scrupulously
              followed. An indiscipline behavior or violation of hostel will be resulted in
              termination of hostel admission.

              I hope read above rules and will abide all the and regulation of hostel




                                                                     Signature of student


        Verified and signed by Host. Supdt.,            Asstt. Warden              Chief Warden
                   Medical College, Bhavnagar – 364001.
                   Under Graduate/Inter/P.G.Student
                       HOSTEL ALLOTMENT LETTER
Roll No :-______________


                                                                    photograph
                                                                   with signature
                                                                  of the candidate




1. Name Of The Student ( In Capital Letters)   :-__________________________________
2. Blood Group ( If You Know )                 :-__________________________________
3. Father's Name                               :-__________________________________
4. Date Of Admission In 1st Mbbs               :-__________________________________
5. Date Of Passing 1st Mbbs                    :-__________________________________
6. Date Of Passing 2nd Mbbs                    :-__________________________________
   Name Of The Batch                           :-__________________________________
7. Date Of Passing 3rd Mbbs                    :-__________________________________
8. Date Of Intership Completion                :-__________________________________
9. Local Guardian's Name Address & Ph. No      :-__________________________________
10.Student Permanent Address & Ph. No          :-__________________________________
11.Date Of Hostel Admission                    :-__________________________________
12. Hostel Block                               :-___________Room No :- _____________
13.Room Partner's Name                         :-__________________________________


To The Best Of My Knowledge, All The Above Information Furnished By Me Are Correct

                                                                    signature of student


Hostel supdt.                       Asstt. Warden           Chief warden
                                          Boys/Girls/Interns Medical Hostels
                                         Medical College Bhavnagar – 364001
                                    Application Form For The Hostel Accommodation

To,
The Chief Warder,
Medical College,
Sir T. Hospital Campus,                                                                     Photograph
Medical College,                                                                               of the
Bhavnagar- 364001                                                                             student

Sir,.

        I here by apply for the hostel accommodation, accordingly I submit following bio-data along with the
necessary document for it.

1.      Name of applicant ( in full )                          :-__________________________________
2.      Father's name ( in full )                              :-__________________________________
3.      Father's occupation                                    :-__________________________________
4.      Permanent residential address                          :-__________________________________
                                                           Distt:-____________ village/city :-___________
                                                          State:-___________________ pin:-___________
                                                          Phone no :-___________________
5.      local guardian/relative's
        name, relation, address
        and phone no                                           :-__________________________________


6.      Details of XII/CBE/III MBBS result                             :-__________________________________
        ( as applicable )
        marks obtained                                                 percentage
        maximum marks                                                  attempt

7.      Category : OM/SC/ST/NT/SEBC/CBE/
                   ALL INDIA/OTHER(specify)                    :-__________________________________

8.      Document enclosed – as applicable
        ( attested copies – only )                               :-__________________________________
        1.XII/CBE/III MBBS mark sheet 2.school leaving certificate              3.caste certificate
        4.passport size photo (2)             5.copy of ration card             6.xerox copy of college Adm. letter
9.      DECLARATION :-
             I shall abide by the rules and regulation of hostel accommodation.

date:-____________                   ______________________                      ______________________
                                      ( signature of candidate )         ( signature of guardian )

                                       ( FOR OFFICE USE ONLY )
1.      Admission granted /not granted                   :-_________________________________________
2.      G.R. No                                          :-_________________________________________
3.      hostel block:-_____________ Room No :-________ :-_________________________________________
4.      Hostel deposit Rs.___________ receipt No:-________________ date :-____________________________
5.      Hostel fee Rs._______________ receipt No:-________________ date:-____________________________
6.    Hostel identity card issued on :-____________________________________________________________

Signature of Hostel Supdt.                   Asstt. Warden                  Chief warden

				
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