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DELHI TECHNOLOGICAL UNIVERSITYEstablished under Govt. of Delhi Act 6 of 2009(Formerly Delhi College of Engineering)

SHAHBAD DAULATPUR, BAWANA ROAD, DELHI - 110042, PH - 27852204

APPLICATION CUM REGISTRATION FORM FOR HOSTEL

ACCOMODATIONACADEMIC YEAR 2012 - 2013

Form No. - 1F699

Message : Form Submitted Successfully! Get pdf version of application form at the bottom of this page | Don't

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For Office Use only

Hostel Name ______ Room No. ______

Dealing Asst. Sign _____________ O/IC Hostels ______________

Basic

Name : Mansi Arora

Gender : femaleCourse : btech

Roll No. / Reg No. : DTU/11/1068

Branch : PCT

Semester : 3

Year of Admission : 2011

Admission category : DOP

Admission Date : : 08/08/2011

Personal Mobile No. : 9711395971

E - mail id : marora_mail@yahoo.comFathers Name : Mr. M. M. Arora

Fathers Phone No. : 9312837129

Fathers Occupation and

Address:

Chartered Accountant, 5/32, Basement, Vikram Vihar, Lajpat Nagar IV,

New Delhi - 110024

Basic

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Signature of Applican

I certify :

1. That I shall vacate my room within 3 days of last examination in each year.

2. That I shall abide the rules and regulaions of University Hostels and the University and shall conduct in a

Basic

Mothers Name : Mrs. Madhu Arora

Mothers Phone No. : 9711472430

Mothers Occupation and Address :Company Secretary, 5/32, 3rd Floor, Vikram Vihar, Lajpat Nagar

IV, New Delhi - 110024

Last School/College attended : Delhi Public School, R. K. Puram

Basic

Present Residential Address (Parents)

Address Line : 5/32, Basement, Vikram Vihar, Lajpat Nagar IV, New Delhi - 110024

City : New Delhi

State : Delhi

Country : India

Pin : 110024

Residential Phone : 01126480740

Present Residential Address (Parents)

Permanent Residential Address (Parents)

Address Line : 5/32, 3rd Floor, Vikram Vihar, Lajpat Nagar IV, New Delhi - 110024

City : New Delhi

State : Delhi

Country : India

Pin : 110024

Residential Phone : 01126480740

Permanent Residential Address (Parents)

Local Guardians InformationLocal Guardians Name : Mr. M. M. Arora

Local Guardians Address : 5/32, 3rd Floor, Vikram Vihar, Lajpat Nagar IV, New Delhi - 110024

Local Guardians Phone : 9312837129

Blood Group : AB+

Chronic Problems if Any : nil

Local Guardians Information

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manner worthy of being a student of DTU and shall never indulge in indiscipline/voilence.

3. That the information furnished by me is true to the best of my knowledge and belief. If any information

found wrong my admission may be cancelled.

Signature of Applican

Declaration by Parents :

I ____________________________________ s/o ___________________________________ undertake that

my ward will maintain good conduct during his stay in the University Hostel. I certify that statements made by

my ward are correct. I undertake to pay/arrange payment of dues regularly and keep regular contact with warden

of the hostel. If my ward is found in any undesirable actvities, his hostel seat may be cancelled.

Signature of the Parent

Date : 10-07-2012

Following Documents will be requires while you submit the form in hostel office (for new registration) -

1. Latest proof of parent's residence. (Latest electricity/water bill/gas connection bill/land line telephone bill)

2. Photocopy of Admission receipt.

3. Hostel certificate from Principal of the school where he/she studied, if he/she is an outsider but studied in

Delhi.

4. Medical fitness certificate issued by govt. authorized doctor.

5. SC/ST/OBC certificate if applicable.

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