Hostel Registration Form

CENTRAL UNIVERSITY OF PUNJAB
www.cup.edu.in
APPLICATION OF REGISTRATION FOR HOSTEL ACCOMODATION
For Office Use:

Attach
Passport
Hostel Registration No:
Size photo
1. Name in full (Block letters)

Mr./ Ms. (As per the original degree)
2. Father/Mother Name (Block Letter)
3. Age and Date of Birth (Proof attached)
4. i) Semester
ii) Session
5. Religion, State and Nationality
6. Do you belong to SC/ST/OBC (if so certificate is

to be attached)
7. Details of the Registration Fee and Hostel Fee
remitted by the students (Fee deposited
receipt is to be submitted with the form)
8. Centre in which admitted
9. University Registration No.
10. Aadhar card number

11. Are you suffering from any chronic disease? Yes/No
If Yes give brief description
(Confirm that copy of medical fitness

declaration and certificate is attached with the
form)
12. Person to be contacted in case of emergency (If Address:

on verification the details provided are found
to be incorrect, strict disciplinary action shall
be taken ) Email:
Mobile:
13. Local Guardian Address:
Email:
Mobile:
14. Present Address Permanent Address
Email: Email:
Mobile: Mobile:
(No column should be left blank)
Declaration by the Applicant
I hereby declare that the information furnished above is true to the best of my knowledge and belief and if admitted,
I shall abide by the Hostel Rules and regulations of the University.
Station:
Date: Signature of the Applicant
Declaration by parents/Guardian
In the event of my ward, Mr./Miss/Mrs. ………………………………………………………………being admitted to the university, I

shall be responsible for his /her conduct, and support the University.
I shall also be liable for all the dues and charges, pending against the name of my ward Mr./
Miss./Mrs……………………………………………………even if he/she leaves the hostel /courses/centre of the University.
Station
Date:
Name, Address and
Signature of Parent/Guardian
Hostel Warden
Chief Warden/ DSW
(FOR OFFICE USE)

Hostel Fees Account sheet:-
Sr. No. Receipt No. Date Amount (Rs.) Paid up to the Semester Remarks, if any
1
2
3
4
5
6
7
8
9
10
Date of Leaving the Hostel……………………………………………………………………………………………………

(Candidate has to submit affidavit in the following format on a duly notarized on Rs.10/- non-judicial Stamp
Paper)
AFFIDAVIT BY THE STUDENT

I,___________________________S/o,D/o______________________________ Resident of
______________________________________________________________ have been admitted to Central
University of Punjab in Program _________________ year________________________
Branch________________ Hostel form No. ___________and has been allotted hostel accommodation at
Central University of Punjab. I am aware of the fact that, keeping any high wattage electronic appliance in
hostel premises is strictly prohibited, and as per rules any student found keeping/using electronic appliance
inside the hostel shall be subject to appropriate disciplinary action including permanent expulsion from Hostel.
I have thoroughly gone through the Hostel Rules and promise to abide by the Hostel Rules in true spirit. I
hereby also undertake that I shall neither indulge myself nor instigate any other student(s) in such activities
such as use of narcotics or create or instigate or compel other to cause or create nuisance in the academic
atmosphere of the University. In case, I am found involved in any act amounting to violation of discipline or
misconduct or the acts falling under the definitions. Breach of above undertaking, disciplinary action be taken
against me as per University rules.
Declared this _______(day) of ________ (month) of _____________ (year) (Signature of candidate)
Name: _____________________ Affidavit by the Parent/Guardian I ________________________

Father/Mother/Guardian of _________________________ a student of Central University of Punjab, am
aware of the law in regard to maintenance of Hostel and University Discipline and I agree to abide by the
punishment awarded to my ward in case he/she is found involved in acts of breach of rules, misconduct,
indiscipline. This undertaking mentioned above by our ward would be binding on us till my ward complete
his/ her studies at Central University of Punjab. In case of any emergency I may be contacted on the following
phone number/s
1.__________________
2.__________________
(Signature of mother) (Signature of father) (Signature of Guardian)
Date: _________________ Place: ________________

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CENTRAL UNIVERSITY OF PUNJAB

For Office Use:

1. Name in full (Block letters)

3. Age and Date of Birth (Proof attached)

5. Religion, State and Nationality

6. Do you belong to SC/ST/OBC (if so certificate is

9. University Registration No.

10. Aadhar card number

If Yes give brief description

(Confirm that copy of medical fitness

12. Person to be contacted in case of emergency (If Address:

Date: Signature of the Applicant

In the event of my ward, Mr./Miss/Mrs. ………………………………………………………………being admitted to the university, I

Chief Warden/ DSW

(FOR OFFICE USE)

Date of Leaving the Hostel……………………………………………………………………………………………………

AFFIDAVIT BY THE STUDENT

Declared this _______(day) of ________ (month) of _____________ (year) (Signature of candidate)

Name: _____________________ Affidavit by the Parent/Guardian I ________________________

(Signature of mother) (Signature of father) (Signature of Guardian)

Date: _________________ Place: ________________

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Declared this _(day) of (month) of _______ (year) (Signature of candidate)

Name: _ Affidavit by the Parent/Guardian I ____

Date: _ Place: