Reg No.:
Room:
Course:
—Please choose an option—GNM I YearGNM II YearGNM III YearBSc Nursing I YearBSc Nursing II YearBSc Nursing III YearBSc Nursing IV YearMSc Nursing Sem 1MSc Nursing Sem 2MSc Nursing Sem 3MSc Nursing Sem 4PBBSc I yearPBBSc II year
Coordinator Name:
Coordinator Phone:
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Arrival Date
Time —Please choose an option—12345678910111200153045AMPM
Vacating date
Vacating Time —Please choose an option—12345678910111200153045AMPM
Declaration:
I have paid the hostel fees as per Institution norms and I am not having any outstanding due fees against me.
I have emailed duly filled No Dues form to Hostel Incharge
I have collected all my personal belongings from the hostel.
I assure you neither I will claim for any of my things left behind in the hostel, nor any of the things lost after my departure from the hostel.
I state that the above declaration is true.