Hostel Vacating Form

Reg No.:

Room:

Course:

Coordinator Name:

Coordinator Phone:

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Parent's photo
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Arrival Date

Time AMPM

Vacating date

Vacating Time AMPM

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.

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Nightingale Institute of Nursing