2. Enrollment No (ukekadu la[;k) .......................................................................................................................

6. Father's Name (firk dk uke) .............................................................................................................................................................

7. Address (irk) ...................................................................................................................................................................................

11. Seniority in the University (fo'ofo|ky; esa ojh;rk) ...........................................................................................................................

12. Local Guardian's Name & Address(LFkkuh; vfHkHkkod dk uke ,oa irk) (1) ..........................................................................................

........................................................Relation with Applicant (vkosnd ds lkFk lEcU/k)..............................................................................

13. Local Guardian's Name & Address(LFkkuh; vfHkHkkod dk uke ,oa irk) (2) ..........................................................................................

..............................................................................................Email (bZ&esy) :........................................................................................

16. Educational Qualification Detail ( ):

3. Course & Semester (d{kk ,oa lsesLVj) ................................Department (foHkkx) ..............................................

............................................................................................................................................................................................................

Examination Passed Board/University Year of Passing Marks Obtained Max Marks %

Receipt of Hostel Application Form / Nk=kokl vkosnu i= dh izkfIr

Serial No. (Øe la[;k)

Course (dkslZ) :

Name (uke) :

S/o, D/o (iq=@iq=h) :

Date (fnukad) :

15. Are you differently able (>40% disability) ('kkjhfjd fodykaxrk 40 izfr'kr ls vf/kd ) .....................................................................gS rks(Attach Certificate / izek.k&i= layXu djsa)

14. Whether outstanding sport person (;fn mRÑ"V f[kykM+h gks rks) ...........................................................................................................(Attach Certificate / izek.k&i= layXu djsa)

10. Family's Annual Income (Rs)(ifjokj dh okf"kZd vk;) ..........................................................................................................................(Attach Certificate / izek.k&i= layXu djsa)

8. Date of Birth (tUe frfFk) ................................................................... Nationality (jk"Vªh;rk) .............................................................

9. Distance(in km) (nwjh&fdeh- esa) ..........................................................(Attach Domicile or equivalent Certificate / led{k izek.k&i= layXu djsa)

State (jkT;) ............................................................................

5. Identity Proof (igpku i=) .................................................................................................................................................................(Attach pc of certificates such as Adhar Card/Voter/Pan Card/Passport/Driving License/Bank Passbook/University ID)

4. Duration of Course (dkslZ dh vof/k) ...............................(For Research scholars only)

Date of Registration (iathdj.k frfFk) ..............................

1. Name of Candidate (fo|kFkhZ dk uke) ...............................................................................................................(In Block Letters)

HOSTEL APPLICATION FORM ¼Nk=kokl vkosnu i=½

Received by/izkIrdrkZ

Re-Registration

Khwaja Moinuddin Chishti Language University, Lucknow.

ijh{kk mRrh.kZ cksMZ@fo'ofo|ky; o"kZ izkIrkad dqy vad izfr'kr

Signature of Student / fo|kFkhZ dk gLrk{kj

Signature / gLrk{kj

Affix your recent self attested coloured

photograph.

viuk u;k Lokizekf.kr jaxhu QksVksxzkQ pLik djsaA

fnukad %& -------------------------------

lgefr&i=

eSa--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

firk@ekrk@vfHkokod vius iq=@iq=h--------------------------------------------------------------------------------------------------------

¼Nk=@Nk=k dk uke½ tks fd--------------------------------------------------------------------- ¼dk;ZØe] l= vkSj

lsesLVj½ esa-----------------------------------------------------------------------------------¼foHkkx dk uke½ Nk=@Nk=k gS] dks

[oktk eqbZuqn~nhu fp'rh Hkk"kk fo'ofo|ky;] y[kuÅ ds ifjlj esa fLFkr Nk=kokl esa Bgjus

dh vuqefr iznku djrk@djrh g¡wA esjk iq=@iq=h iw.kZr% LoLFk gS rFkk mlesa dksfoM&19 ds

dksbZ y{k.k ugha gSaA og dksfoM&19 ds fn'kk&funsZ'kksa dk ikyu djus gsrq izfrc)

jgsxk@jgsxhA

Nk=@Nk=k dk uke % --------------------------------------

d{kk % -------------------------------------------------------------

d{k la0 % -----------------------------------------------

Nk=@Nk=k dk eks0ua0 % ----------------------------------

Nk=@Nk=k dk gLrk{kj % -------------------------------

firk@ekrk@vfHkHkkod dk uke % --------------------------------

LFkk;h irk % ------------------------------------------------------------------

----------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------

vfHkHkkod dk eks0ua0 % ----------------------------------------------------

vfHkHkkod dk gLrk{kj % -------------------------------------------------

bZ&esy vkbZ0Mh0 % --------------------------------------------------------

HOSTEL FEE STRUCTURE

Sr. No.

Heads of Fee New Allotment Single Occupancy

in Rs) per year.

Renewal Occupancy (in Rs)

per year. Total Total 1 Admission Fee 100 100 2 Maintenance Fee (Electrical +Civil) 200 200 3 Common Room Charges 200 200 4 Kitchen Maintenance/Crockery

Utensils 250 250

5 Cultural activities charge including magazines

175 175

6 Sports 100 100 7 Room Rent 6000 6000 8 Electricity/water charges 1000 1000 9 Caution Money (Refundable) 1000 -

Total 9025 8025 Mess Fees Rs. 2,385/- per month, Rs. 3,000/- Mess Security Money (Refundable/Adjustable) The Mess Charge will be vary time to time after recommendation of Committee.

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