Affixa
HOSTELALLOTMENTFORM2016-17
DEPARTMENT:___________________________________________
PassportSize
Photograph
Date:
PERSONALDETAILS
1. NameoftheStudent
:___________________________________________
2. RollNo./AppnNo:/JEENo
:___________________________________________
3. NameoftheDegree
:___________________________________________
4. NameoftheDeptt.ofstudies :___________________________________________
5. YearofStudy(class/division)
:___________________________________________
6. BloodGroup
:______________Rh__________________________
7. EmailID :___________________________________________
8. MobileNo.
:___________________________________________
:___________________________________________
2. Mother’sName :___________________________________________
3. PermanentAddress
:___________________________________________
PARENTS’DETAILS
1. Father’sName
___________________________________________
___________________________________________
_____________________PIN__________________
Tel.No.:___________________________________
4. AddressforCorrespondence
:___________________________________________
___________________________________________
___________________________________________
_____________________PIN__________________
Tel.No.:___________________________________
MobileNo.:_________________________________
EmailID:___________________________________
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page1of12
5. Father’sOccupation
:___________________________________________
6. Father’sOfficeAddress :___________________________________________
___________________________________________
___________________________________________
_____________________PIN__________________
Tel.No.:___________________________________
MobileNo.:_________________________________
EmailID:___________________________________
7. Mother’sOccupation
:___________________________________________
8. Mother’sOfficeAddress :___________________________________________
___________________________________________
___________________________________________
_____________________PIN__________________
Tel.No.:___________________________________
MobileNo.:_________________________________
EmailID:___________________________________
LOCALGAURDIAN’S(LG)DETAILS
1. NameofLGinDelhi
:___________________________________________
2. RelationofLGwithstudent
:___________________________________________
3. ResidenceAddressofLG:
___________________________________________
___________________________________________
___________________________________________
_____________________PIN__________________
Tel.No.:___________________________________
MobileNo.:_________________________________
EmailID:___________________________________
4. OccupationofLG
:___________________________________________
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page2of12
5. OfficeAddress
:___________________________________________
___________________________________________
_____________________PIN__________________
Tel.No.:___________________________________
I,_______________________________________________(NameoftheFather/Parent),hereby
declarethat__________________________________________________(Nameofthenominated
LocalGuardian)ismy_________________________________(RelationofFather/ParentwithLocal
Guardian)andInominatehim/herasaLocalGuardianofmyward_______________________
_______________________________________________(Nameofthestudent).
I,_______________________________________________(NameoftheLocalGuardian),havebeen
nominatedasaLocalGuardianfor____________________________________________(Name
ofthestudent)duringhis/herstayintheHostelbyhis/herfather/parent___________________
______________________________(NameoftheFather/Parent).Iamwillingtoactforthesame.
Thecopy(ies)of_______________________________________________(Nameofthedocument/
documentsofLocalGuardian),is/areenclosedherewithasaproofofIdentityandaddress.
Certifiedthat:
i.
Weshallundertaketopayallduesinrespectofmyward.
ii.
WetakefullresponsibilityofourWardandassurethathe/shewouldmaintaindesired
disciplineandabidebyallRules&RegulationsofHostel/MessoftheSchool.
iii.
Weassurethatincaseofmis-conduct,weshallarrange/makealternatearrangementfor
stayofourWardwithin48hoursofthereceiptofinformationfromSchool.
iv.
Weassurethatintheeventofanychangeofaddress/phonenumber(s),weshallinform
theSchoolimmediately.
__________________________
__________________________
SignatureofParent/Guardian
SignatureofLocalGuardian
Date:____________________
Date:____________________
Place:___________________
Place:___________________
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page3of12
ANTI-RAGGINGUNDERTAKING
I _____________________________ son / daughter of _______________________________
herebygiveanundertakingthatIshallnotindulgedirectlyorindirectlyinanyformofRAGGING
withinoroutsidethepremisesoftheHostelComplex/School.AndincaseIamfoundguiltyin
anycaseofRAGGINGbytheauthoritiesoftheHostel/School,Ishallbeliabletobepunishedas
determinedbytheauthoritiesoftheHostel/School,whichmayincludethefollowing.
(i) ExpulsionfromtheSchool;
(ii) SuspensionfromtheSchoolorClassesforalimitedperiodorfinewithpublicapology;
(iii) Withholdingscholarshiporotherbenefits;
(iv) Debarringfromrepresentationinevents;
(v) Withholdingresults;
(vi) ExpulsionorsuspensionfromtheHostelorMess;etc.
SignatureoftheStudent:
_______________________________
NameoftheStudent:
_______________________________
(inBLOCKLetters)
RollNo.: _______________________________
Department: _______________________________
CountersignedbytheParents/Guardian
Parents/GuardianSignature:_______________________________
Name:_________________________________________________
(inBLOCKLetters)
Address:_______________________________________________
_______________________________________________________
MobileNo.:_____________________________________________
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page4of12
PAYMENTDETAILS
DetailsofPayments
Amount
ReceiptNo.
Date
Vertified
HostelFee
MessDeposit(OnlyforNew
HostelAdmission)
MessEstt.Charges
MessAdvance
OtherDues
(ForOfficeUse)
DOCUMENTS-ATTACHED&FILLED
Sr. NameoftheDocuments
Yes
No
Remarks
1.
FormforAllotment
2.
LetterFromFather/ParentsforNominationofLocal
Guardian
3. DocumentaryEvidenceoftheResidenceof
Father/Parents
4. DocumentaryEvidenceofthePlaceofEmploymentof
Father/Parents
5.
DocumentaryEvidenceoftheResidenceoftheLocal
Guardian
6.
SignedcopyofHostelandMessRulesandRegulations.
7.
Undertakingfornon-involvementinRAGGING
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
(ForOfficeUse)
Page5of12
HOSTELANDMESSRULES(HOSTELOFFICECOPY)
I, _______________________________________________ (Name of the Student) have carefully
gone through the Hostel and Mess Rules, provided to me along with this Form and solemnly
undertaketoabidebyandobservethesamefully.Iunderstandthatmyfailuretocomplywith
the rules and regulations of the Hostel will render me liable to disciplinary action including
expulsionfromtheHostel.
IamseekingadmissiontotheHostelinfullknowledgeoftheHostel/Messrulesasunder:
HostelRules:
1. Residentstudentsarestrictlyforbiddentovisitthehostelroomsofmembersofopposite
sex.
2. Useofnarcoticsconsumptionofalcoholicbeveragesandgamblingatthehostelpremises
arestrictlyprohibited.
3. Playingofaudioequipmentintheroomsaswellasinthestudent’scommonroomsshall
bekeptatalowpitchsothatitdoesnotdisturbotherresidents.
4. A guest/ visitor of the same sex may stay overnight in the Hostel room provided the
roommategiveshis/herconsent.Suchguestmaystayfortwodayswhiletheconcerned
residentshallinformthehostelWardenwithin12hoursaheadoftheguests’arrival.The
residentshallobtainpermissionoftheHostelWardenforextendingthestayoftheguest
over more than two days. The period of stay of the guest can be extended at the
maximum to 4 days. Resident student shall be charged for accommodating such guest/
[email protected]/-(RupeesTwentyFiveonly)perdayandnoguest/visitorshallbeallowed
tostayformorethan5daysinamonth.
5. ForbothBoy’sandGirl’sHostelsnolatenightentrywillbepermittedbeyond10.00P.M.
and only one night out per week be allowed for visiting friends and relatives on the
specificpriorpermissionoftheHostelAuthorities/Dy.Warden/HonoraryWardenofthe
Hostel.
6. Thevisitorofthesamesexwillberequiredtoenterhis/hername;addressandthetime
of entry in the register kept at the Reception of the Hostels and also identify himself/
herselfthroughI-Cardetc.wheneveraskedbytheSecurityGuard/Chowkidar/Caretaker/
Dy.Warden/HonoraryWardenoftheHostel.
7. TheHostellersareforbiddentoplayanygameinlawns/openspacesoutsidetheHostel
building that may cause damage to the properly of the School and disturb or cause
discomfortandinconveniencetootherresidents.
8. Hostel Office at I.P. Estate (ITO) and Estate Office at Maharani Bagh may provide bulbs
andtubesinalimitednumberstoindividualroomsifavailableintheSchoolStore.
9. The residents shall not spoil, deface the walls, furniture and cupboards etc. They shall
alsonotalterortemperwithelectricwiringandfittings.Incasesomedamagesaredone
he/ she shall be liable for three times recovery of the value assigned by the Hostel
Authorities.
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page6of12
10. Hostelresidentshallstayintheroomallottedtohim/herandwouldnotbepermittedto
shiftroomincasesuchincidentsisbroughttothenoticehis/herroomallotmentwillbe
cancelled.
11. HostelresidentshallshifttoanotherroomofvacatetheHostelifrequired/directedby
theHonoraryHostelWardenfordecisiontakenintheinterestoftheSchool.
12. Resident students shall observe decency and decorum in the Hostel and generate a
healthyandwholesomeenvironment.Anyactofintimidation,violenceorwillfuldamage
shallbeliablefordisciplinaryactionbyHostelAuthorities.
13. Resident who expect to be away from the Hostel for a short period exceeding one day
shall inform the Warden Deputy Warden of his/ her absence, indicating their contact
addressandtheprobabletimeoftheirreturn.
14. Resident student shall vacate rooms immediately on the completion of the academic
termandhandoverthechargeoftheroomincludingalltheitemsoffurniture/fixtures
suppliedtothemonadmissiontotheHostel,totheHostelCaretakeroranyotherofficial
ofthehostelauthorizedbytheHonoraryHostelWarden.
15. Inmatesarerequiredtokeeptheirpersonalbelongingsintheirsafecustody.Anytheftor
lossofsuchpersonalitemswouldbethesoleresponsibilityofthehostelinmate.
16. AspernotificationoftheGovt.ofIndiaregardingdamagetopropertyandequipmentin
the institution as a result of any demonstrations/ strikes charges would have to be
recovereddirectlyformthosestudentsinvolvedinsuchincidents.
MessRules:
1. Messiscompulsoryforallthehostellers.
2. AlltheHostellerswillbeissuedMessCouponswithrespectivedate,mealtypeandmeal
preference, which will have to be handed over to the authorized person of the Mess
againstwhichthemealwillbeserved.
3. IfanyhostellerdoesnotwanttodineintheMess,he/shehastoseekspecialpermission
fromtheHonoraryHostelWarden.Thepermissionwillbegivenonthebasisofwritten
application with valid reason and returning the coupons for the period, before
commencementoftheperiod.
4. For those permitted, Rs.500/- (Rupees Five hundred only) as Non-dining Charges (NDC)
permonthwillbecharged.NoMealshallbeservedtotheHostellerswhohaveoptedfor
MessOff/NDC.
5. NostudentisallowedtotakeMessutensilsoutsidetheHostelDiningRoomifanybodyis
foundtakingutensilsoutsidetheMess,he/sheshallbefinedRs.100/-(RupeesHundred
only).
6. Food will be served by Hostel Mess Employees in the room, on demand (minimum 3
hoursnoticeisrequired)onlytothesickstudents.
7. Guests of students, staff and members of faculty will only be provided service against
couponspurchasedinadvanceinthedininghallonlyoftherespectiveMess.
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page7of12
8. Rebate for pre-paid Mess Coupons may be allowed provided three day’s notice and
returnofMessCouponsinadvance,givenunderthefollowingconditions:
•
Outstation tours (Educational/ Study Tours/ Training/ Academic related activities)
withapplicationsapprovedthroughHOD.
•
Minimum 2 days upto a maximum 8 days per month of authorized absence from
HostelforwhichperiodapprovalofHonoraryHostelWardenisrequired.
SignatureoftheStudent
Date:______________________
Place:_____________________
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page8of12
1. NameoftheStudent
:___________________________________________
2. RollNo. :___________________________________________
3. NameoftheDeptt.ofstudies :___________________________________________
4. YearofStudy(class/division)
:___________________________________________
5. EmailID :___________________________________________
6. MobileNo.
:__________________________________________
HOSTELALLOTMENTDETAILS
ForOfficeuseonly&ToBeFilledbyHostelOfficeStaff
HostelAllotted:
ITOGirlsHostel
MaharaniBagh(MB)Girls’Hostel
MaharaniBagh(MB)Boys’Hostel
RoomAllotted:
MESSDETAILS
MealPreference:
Non-vegetarian
Vegetarian
Lunchoff:
(ExcludingHolidays)
Yes
No
CouponNo: SignatureoftheHostelAuthority
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page9of12
HOSTELANDMESSRULES(STUDENTCOPYtoberetainedbythestudent)
I, _______________________________________________ (Name of the Student) have carefully
gone through the Hostel and Mess Rules, provided to me along with this Form and solemnly
undertaketoabidebyandobservethesamefully.Iunderstandthatmyfailuretocomplywith
the rules and regulations of the Hostel will render me liable to disciplinary action including
expulsionfromtheHostel.
IamseekingadmissiontotheHostelinfullknowledgeoftheHostel/Messrulesasunder:
HostelRules:
1. Residentstudentsarestrictlyforbiddentovisitthehostelroomsofmembersofopposite
sex.
2. Useofnarcoticsconsumptionofalcoholicbeveragesandgamblingatthehostelpremises
arestrictlyprohibited.
3. Playingofaudioequipmentintheroomsaswellasinthestudent’scommonroomsshall
bekeptatalowpitchsothatitdoesnotdisturbotherresidents.
4. A guest/ visitor of the same sex may stay overnight in the Hostel room provided the
roommategiveshis/herconsent.Suchguestmaystayfortwodayswhiletheconcerned
residentshallinformthehostelWardenwithin12hoursaheadoftheguests’arrival.The
residentshallobtainpermissionoftheHostelWardenforextendingthestayoftheguest
over more than two days. The period of stay of the guest can be extended at the
maximum to 4 days. Resident student shall be charged for accommodating such guest/
[email protected]/-(RupeesTwentyFiveonly)perdayandnoguest/visitorshallbeallowed
tostayformorethan5daysinamonth.
5. ForbothBoy’sandGirl’sHostelsnolatenightentrywillbepermittedbeyond10.00P.M.
and only one night out per week be allowed for visiting friends and relatives on the
specificpriorpermissionoftheHostelAuthorities/Dy.Warden/HonoraryWardenofthe
Hostel.
6. Thevisitorofthesamesexwillberequiredtoenterhis/hername;addressandthetime
of entry in the register kept at the Reception of the Hostels and also identify himself/
herselfthroughI-Cardetc.wheneveraskedbytheSecurityGuard/Chowkidar/Caretaker/
Dy.Warden/HonoraryWardenoftheHostel.
7. TheHostellersareforbiddentoplayanygameinlawns/openspacesoutsidetheHostel
building that may cause damage to the properly of the School and disturb or cause
discomfortandinconveniencetootherresidents.
8. Hostel Office at I.P. Estate (ITO) and Estate Office at Maharani Bagh may provide bulbs
andtubesinalimitednumberstoindividualroomsifavailableintheSchoolStore.
9. The residents shall not spoil, deface the walls, furniture and cupboards etc. They shall
alsonotalterortemperwithelectricwiringandfittings.Incasesomedamagesaredone
he/ she shall be liable for three times recovery of the value assigned by the Hostel
Authorities.
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page10of12
10. Hostelresidentshallstayintheroomallottedtohim/herandwouldnotbepermittedto
shiftroomincasesuchincidentsisbroughttothenoticehis/herroomallotmentwillbe
cancelled.
11. HostelresidentshallshifttoanotherroomofvacatetheHostelifrequired/directedby
theHonoraryHostelWardenfordecisiontakenintheinterestoftheSchool.
12. Resident students shall observe decency and decorum in the Hostel and generate a
healthyandwholesomeenvironment.Anyactofintimidation,violenceorwillfuldamage
shallbeliablefordisciplinaryactionbyHostelAuthorities.
13. Resident who expect to be away from the Hostel for a short period exceeding one day
shall inform the Warden Deputy Warden of his/ her absence, indicating their contact
addressandtheprobabletimeoftheirreturn.
14. Resident student shall vacate rooms immediately on the completion of the academic
termandhandoverthechargeoftheroomincludingalltheitemsoffurniture/fixtures
suppliedtothemonadmissiontotheHostel,totheHostelCaretakeroranyotherofficial
ofthehostelauthorizedbytheHonoraryHostelWarden.
15. Inmatesarerequiredtokeeptheirpersonalbelongingsintheirsafecustody.Anytheftor
lossofsuchpersonalitemswouldbethesoleresponsibilityofthehostelinmate.
16. AspernotificationoftheGovt.ofIndiaregardingdamagetopropertyandequipmentin
the institution as a result of any demonstrations/ strikes charges would have to be
recovereddirectlyformthosestudentsinvolvedinsuchincidents.
MessRules:
1. Messiscompulsoryforallthehostellers.
2. AlltheHostellerswillbeissuedMessCouponswithrespectivedate,mealtypeandmeal
preference, which will have to be handed over to the authorized person of the Mess
againstwhichthemealwillbeserved.
3. IfanyhostellerdoesnotwanttodineintheMess,he/shehastoseekspecialpermission
fromtheHonoraryHostelWarden.Thepermissionwillbegivenonthebasisofwritten
application with valid reason and returning the coupons for the period, before
commencementoftheperiod.
4. For those permitted, Rs.500/- (Rupees Five hundred only) as Non-dining Charges (NDC)
permonthwillbecharged.NoMealshallbeservedtotheHostellerswhohaveoptedfor
MessOff/NDC.
5. NostudentisallowedtotakeMessutensilsoutsidetheHostelDiningRoomifanybodyis
foundtakingutensilsoutsidetheMess,he/sheshallbefinedRs.100/-(RupeesHundred
only).
6. Food will be served by Hostel Mess Employees in the room, on demand (minimum 3
hoursnoticeisrequired)onlytothesickstudents.
7. Guests of students, staff and members of faculty will only be provided service against
couponspurchasedinadvanceinthedininghallonlyoftherespectiveMess.
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page11of12
8. Rebate for pre-paid Mess Coupons may be allowed provided three day’s notice and
returnofMessCouponsinadvance,givenunderthefollowingconditions:
•
Outstation tours (Educational/ Study Tours/ Training/ Academic related activities)
withapplicationsapprovedthroughHOD.
•
Minimum 2 days upto a maximum 8 days per month of authorized absence from
HostelforwhichperiodapprovalofHonoraryHostelWardenisrequired.
SignatureoftheStudent
SignatureoftheHostelAuthority
Date:______________________
Place:_____________________
HostelOffice,SchoolofPlanningandArchitecture,4B,IPEstate,NewDelhi110002
Page12of12