NOTE: ALL ENTRIES ARE TO BE FILLED IN. INCOMPLETE APPLICATION FORM WILL NOT BE ENTERTAINED
Form No.
Rs. 40.00
HEMWATI NANDAN BAHUGUNA GARHWAL UNIVERSITY
SRI NAGAR {GARHWAL) UTTARAKHAND
{A Central University)

Hostel Application form for the Session 2013-14
Instructions:
(a) Please attach the followings:
1. Two Latest Photographs
The Photo
should be Attested
by the
warden/Chief
Warden

2. Attested photo copy of the Residence proof ( Rashan CardNoter I. D./Driving Licence/Electric bill/Passport, etc.)
3. Attach Attested Photo copies of all relevent documents.
(b) The admission will be valid for the current academic session only.
(c) Incorrect information may cause cancellation of admission.
1 Name of Student (in Block Letters)
/rn?rl Cfil1TI1
2 Father's Name
ftmrCfil1P1
3 Mother's Name
lffilT CfiT 1P1
4 Date of birth (Day, Month, Year)
\lFi1 fuf (, . qof)
5 Class to Which Admitted (also
state subject in case of Post Graduate &
Research Students)
<li'an m tWn t cf1 1('1Cf>,k\'1{
W q;) fcrir<:f '1ft CflBT I)
6 Do you belong to SC/ST/OBC? (if
yes, attach photo copy of Certificate
issued by competent authority)
cp:rr 31Til 0/0\ifO 0/aR
%? c m"ill>fl1TUI)
7 Permanent Address and
Phone No. of parents
lffilT- ftmr CfiT 11cfT (f 1:fiT;:r -;lo
8 Name and Address of Local Guardian
(Phone No .IF ax/Mobile/ e-mail)
-;lo 11 tito/t-mvr)
1
9 Address of Parents for Correspondence
(if different from Sl. No. 7 above)
(Phone No. /Fax/Mobile/ e-mail)
llTffi - i1«fT Cfil 4 5I Oll <"H\1 { Cfil 11cfl ( Sfl. "'fi. 7 'B
f'lA m ('fiR -;:fo // l1lo;i-)
10 Blood Group of the Student
frn?!T Cfil '{q{J
11 Details of the Medical Problems Suffered
by the Student (if any)
cp:n 31Nfcnmt I
12 Are any Legal Proceedings Pending
against you in any Police Station/ Court of
Law (if yes, give details)
q<n fcnm /
II(.Yl -q'TfflWT%? m'ffi)
13 Date & No. of Receipt of Admission Fees
(Attach Photo copy of Receipt/ Registration
Certificate/Letter of guide)
mcit"'fiO(citIISifu
)/'W'=l Y"llCfl{OI citfuf ( qCf){OI
'4?f cit >l'fu )
14 Name of the Research Supervisor
(only for ResearchScholars)
&TCfl Cfil ( AA'?IT q;-)
15 Were you allotted hostel earlier? Year Room No. & Name of the Hostel
(if yes, indicate the details) 'Cfil1U ';f0 "Q;Cf I ?II Cl I '8 Cfil ';fl1i
q<n \ft I?IICIItl-q m 1lGIT
mm
16. Details of Educational Qualifications:
a:Tctl' -3TI Cfil
(Attach attested copies of Mark Sheets)
(cit fl('<:llfllo IISifuj cR)
Sl. Exam Passed Year of Board/ Subjects Total Division Percent
No. lffi&n Passing University 'fcr5l<1 Marks age
Sfl. arrt; Obained
1. High School
2. Intermediate
3. B.A./B.Sc./B.Com./BBA
4. M.A./M.Sc./M.Com.
5. MCNMBA
6. Others
2
Declaration to be signed by the Student
I ... 000 00.00 00 00 ............. 00 ......................... 00 00 00 00 00 son/daughter of
Shri ............. 00 ..................... 00 00 00 00 00 00 00 00 00 000 00 00 Village and Post
Office .......... 00 00 00 00 00 00 ................... 00 00 District .... 00 00. 00 00 00 00 00.00 00 00.
hereby declare that the information furnished above is correct to the best of my knowledge and
belief. If any information furnished by me is found to be incorrect, I may be expelled from the hostel
of the University. I have read and understood all the rules of admission to reside in a hostel of the
University and shall abide by them. If I am found to have violated any rule at any time, I will be liable
for disciplinary action by the hostel administration/the University.
Date Name Signature

Undertaking by the Guardian
I ...................... .................................. hereby declare that Shri/Km ........................................... is my
ward. I nominate shri/Mrs . ..................................... ...................... the relevant information about whom
is furnished below, as his/her local guardian. If my ward Shri/Km ........... .................. ...... .... ........... .
vioates any rules or regulations of the Hostel, disciplinary action may be taken against him/her in
accordance with the disciplinary rules of the hostel/University.

Details about Shri/Mrs .......................................................................................... who has been
nominated by me as the Local Guardian of my ward are as:
mt ..................................................................... Cfil fc:lccOI i'ttiDrf Cfil
MY)Ck1 fcom 'tlm' t:
Name of Local Guardian
Relation with the boarder
Profession
Address :
Contact Phone Number :
Signture of the Local Guardian :
Signature of Guardian :
Forwarding remarks of Head ofthe Department/Dean of the School
Date : Signature a:R : Seal of Office
(PG, Pre-Ph.D. and Research students shall get their applications forwarded by the Head of the
Department concerned, and UG students shall get their applications forwarded by the Dean
of the School concerned.)
Recommendation of the Hostel Admission Committee
Shri/Km .................................................................................................. is recommended for admission
to ...................................................................................... on the basis of his/her relative merit.
Member 1 Member2 Convener
Date: Signature of Chief Hostel warden

Verification Form (To be filled by the student)
1. Name ......................................... ..... Class ..................... Subject. .................. ..
"iTB ............................. .. ..................... Cfi ........................ ....................... .---Th-e-P-ho-to--.
should be Attested
2. Father's Name......... .......................... ......... .................................................... by the
ft«:ry CfiT "iTB........ .... ................... .... . . . . ... .. .. .. . . . .. . . . . . .. .. . . . . . . . .. ... .. ... . . . . . . . .. . . . . . . . . . . . . . . . wa:;1ef
3. Mother's Name .............................................................................................. .
"J:{TffiCfil ... . ... ................ . . ............................................................
4. Date of birth (Day, Month, Year) ........................... .................... ............ .......... ..
fuf (, Cfl'f) ................................................................................... .
5. Catagory (SC/ST/OBC) .............................................................................. ..
........................................ .
6. PermanentAddress ................... ............. ..... .................................................. .
.. .. ....................................................................................................... .
7. Address of Parent for Correspondence (if different from above)
(Phone /Fax/E-mail)/ Mobile ........................................................................ ..
.......................................................................... .
8. Name and Address of Local Guardian ......................................................... .
............................................................. ........................ .
Phone/Fax/ E-mail /Mobile ........................................................................... .
.................................................................................. .
9. Room No ......................... Name of the Hostel ........................................... ..
Cfi11'n' 1'0. . . . .. .. . . . . . . . . .. . . ........................... .............. ..
10. Hostel/Admission fee Receipt No .................... Date ............. Signature of Clerk

Signature of Chief Hostel Warden
Signature of Hostel Warden
-------------------------------------
Acknowledgement of Hostel Application Form, 2013-14
Received Application From Mr./Ms./Shri/Smt. .............................................................. ..
Serial No .................... for admission to the Hostel.
Date : .......... / ......... /2013 Signature of Office lncharge
Form No
BANKS COPY
STATE BANK OF INDIA 0
CHALLAN FOR REMITIANCE OF HOSTEL FEES
FOR HNB GARIIWAL UNIVERSITY SRINAGAR
GARHWAL (UK)
"POWER JYOTI CURRENT ACCOl "'T No. 32497759688
Applicant's Name (To be foiled by candidate applicant)
Mr.IMs ..
Date of Birth
Father's Name
Class/Course
NAME OF HOSTEL
HOSTEL FEES Rs
(IN WORDS)
TO BE FILLED BY THE BANK
BRANCH NAME AND CODE
JOURNAL NO
DATE OF DEPOSIT
Signature of
Remttter
Offictal wtth Branch Seal
Stgnaturc of authorized
(No charges/Commission need to be coiiected by the branch As
per CGM SME circular No NBGIS\tEBl
POWERJYOTUS0/2011-12
Dated 16/09nOII
Branch Should write the Branch name, Branch Code, Journal
No & date of Remittance on the challan tn vanably and
hand over both HNBG Universtty Srmagar and applicant's
copy to the remttter duly stgned
Kmdly accept challan on!} after the seal and os stgnature of
Chtef Hostel Warden HNBGU srinagar
Thos chaiian does not ensure admtss1on mto hostel
HNBGU reserves the nghts to ta e admission into Hostel
Form No.
UNIVERSITY COPY
STATE BANK OF INDIA 0
CHALLAN FOR REMITIANCE OF HOSTEL FEES
FOR HNB GARHWAL UNIVERSITY SRINAGAR
GARHWAL (UK)
"POWER JYOTI CURRENT ACCOUNT No. 32497759688
Applicant's !\arne !To be tilled by candidate applicant)
Mr /Ms
Date of Borth
Father's Name
Ctass'Course ..
NAME OF HOSTEL
HOSTEL FEES Rs
(IN WORDS)
TO BE FILLED BY THE BANK
BRANCH NAME AND COD I:.
JOURNAL NO
DATE OF DEPOSIT
S1gnature of
Remitter
Official wnh Branch Seal
Signature of authorized
(1\o charges/Commission need to be coiiected b) the branch As
per CGM SME circular No NBGISl\IEBll
POW ERJYOTI/50/2011-12
Dated t6/09n011
Branch Should write the Branch name, Branch Code, Journal
No. & date of Rem1ttance on the challan in variably and
hand over both HNBG University) srinagar and applicant's
copy to the rem1tter duly s1gned
Kmdly accept challan onl) after the seal and IS Signature of
Ch1ef Hostel Warden HNBGU srinagar
This chaiian does not ensure admission into hostel
HNBGU reserves the rights to take admission into Hostel
Form No.
CANDIDATES COPY
STATE BANK OF INDIA 0
CHALLAN FOR REMITIANCE OF HOSTEL FEES
FOR HNB GARHWAL UNIVERSITY SRINAGAR
GARHWAL (UK)
'·POWER JYOTI CURRENT ACCOl fliT l"' o. 32497759688
Applicant's Name (To be filled by cand1date applicant)
Mr /Ms
Date of Borth
Father's Name
Class/Course
NAME Or HOSTEL
HOSTEL FEES Rs
(IN WORDS)
TO BE FILLED BY THE BANK
BRANCH NAME AND CODF
JOURNAL NO
DATE OF DEPOSIT
S1gnature of
Remitter
Official w1th Branch Seal
S1gnature of authorized
('lo charges/Commission need to be collected by the branch As
per CGM SME circular No 1\BGISMEBU
POWERJ\ OTI/50/2011-12
Dated 16/09/20 II
Branch Should wnte the Branch nan1e, Branch Code, Journal
No. & date of Remittance on the challan in van ably and
hand over both HNBG Umverslly Srinagar and applicant's
copy to the remitter duly signed
Kindly accept challan only after the seal and is signature of
Chief Hostel Warden HNBGU Srinagar
This challan does not ensure admission into hostel HNBGU reserves the rights to take admission into Hostel