ANNEXURE I. Following items are provided in each room.
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1 ANNEXURE I Following items are provided in each room. S.N. Items Quantity 1 Door Stopper 1 2 Safety Chain for the main door -per room 1 3 Wooden Bed with wheeled drawers below 3 4 Mattress for each Bed 1 5 Window Curtains cloth with 1 curtain Rod, Clamp 4 6 Mosquito nets for window 2 7 Study Table 3 8 Plastic Chair 3 9 Cupboard 3 10 Ceiling Fan 2 11 LED Ceiling Lights with cover 3 12 Sockets for plug point 3 13 Dressing Mirror in the room 1 14 Mirror in the bath room 1 15 Shower in the Bathroom 1 16 Tooth Brush stand 1 17 Soap Stand 1 18 Steel Toiletry Basket 3 19 Bucket 2 20 Mug 2 21 Western Commode 1 22 Wash Basin 1 23 Cloth Hangers 2 24 LAN Port 3 Date : Vidyavihar, Mumbai Student s Signature Student s Name : SIMSR-Hostel/ver 5.0/ SIMSR Hostel - Vidyavihar Page 1 of 6
2 ANNEXURE -II K. J. SIMSR Stick Recent Photograph APPLICATION FORM FOR ADMISSION TO HOSTEL Personnel Details of student Application Date: (Date on which form is filled) Name : Course Applied for : Collage Name to Join : Course Year : I / II / III /IV (Tick as applicable) Date of Joining : For Academic Year : (1 st day of stay in hostel) Date of birth : Sex: Male/Female: Mobile : Medical History of the Applicant Blood Group : Allergy if Any : Prescribed regular medication: Family Doctor s Name Doctor s Phone No. Permanent address of : Parent /Guardian Name: Address Line1: Address Line2: Address Line3 : (suberbane City Name in case of Mumbai ) State : Pin Code: Res-Phone : Mobile SIMSR-Hostel/ver 5.0/ SIMSR Hostel - Vidyavihar Page 2 of 6
3 Local guardian details/ Contact details in case of emergency Name: Address Line1: Address Line2: Address Line3: State : City: Pin Code: Phone : Mobile Relationship with the student : Phone: Friend s contact Guardian s Instructions Paid Rs...vide DD/Pay Order no. dated Allotted room no. : Dt: of Room Allocated : Dt: of Cancellation: Date To vacate by : (If admission is withdrawn by student) Hostel Warden Director SIMSR-Hostel/ver 5.0/ SIMSR Hostel - Vidyavihar Page 3 of 6
4 UNDERTAKING ANNEXURE III The Hostel authorities of K.J. SIMSR Hostel wish all students and their parents a very warm welcome. The hostel under the direction of the Director of SIMSR, has this undertaking made for the parents to accept the following terms and conditions mentioned below for the safety and smooth functioning of the hostel. If the terms and conditions are acceptable ONLY then this undertaking may be signed. An acknowledge photocopy of this form will be given to the parents and the original retained by the hostel authorities. TERMS & CONDITIONS 1. The Hostel Rule Book is read by me and my parents and acceptable to us I undertake to obey under all circumstances the rules pertaining to: (1) No-Ragging or any type of sexual harassment, (2) No-Smoking, (3) Non- Consumption of Alcohol or any toxic substance, and (4) Non-Consumption of Nonvegetarian food, in the hostel or within the Somaiya campus. If I am found guilty, I understand that I will be immediately expelled from the hostel premises and I undertake to accept such an action. 4. I undertake to follow all details regarding to late coming to the campus ie to return before p.m. a. If I am found entering the campus after p.m. without permission I accept to pay the penalty of Rs. 1000/- for the first time. b. I accept to pay the penalty of Rs. 2000/- for the Second time entering late. c. If I am entering the campus late for the 3 rd time I agree to the rule that I will be expelled from the hostel immediately with no excuse entertained. 5. I undertake to follow all details regarding going out of the campus before 6.00 a.m. or arriving late after p.m., I will fill up the form on the previous day before 8.00 p.m. 6. In case of emergency the hard copy of Leave Application will be filled and signed by me and inform the Warden, get it stamped by the respective hostel security and hand over the copy, to the security guard at the gate no. 1 or gate no Under no circumstance I shall come late or leave the campus early without permission. 8. I shall take the Gate Pass from the care taker of the hostel office for availing the permission to leave the hostel at early hours or come late to the hostel. So the SIMSR-Hostel/ver 5.0/ SIMSR Hostel - Vidyavihar Page 4 of 6
5 permission can be produced to the security guard at the gate no. 1 or gate no. 2 while coming late or leaving early. 9. Due to any of the college activities, if I have to leave early or come late, I shall take the signature of my Program Coordinator and the Warden on the hard copy application stating the same and hand over the copy duly signed, to the security guard at the gate no. 1 or gate no. 2 while coming late or leaving early. 10. I undertake to keep my room and the common passages, the hostel ambience and the campus clean and will never litter it with any kind of wrappers or any other thing. If found littering, I agree to pay a fine of Rs. 1000/- each time. 11. I agree not to involve myself in ragging activities or any type of sexual harassment nor participate with others, nor carry out any such activities. I agree that if I am found guilty I will leave the hostel without giving any excuse. I know that under such circumstances, the hostel charges and the deposits paid by me will be forfeited by SIMSR. 12. I agree to pay the respective fine as mentioned in the hostel equipment list in case any damage is caused by me in my room or in the passage. 13. I undertake to pay the respective fine as defined by the authorities for any damage caused by me while using the lift in the hostel. 14. I agree to abide by all the rules and regulations mentioned above and ensure safety and prevent the hostel and its surroundings from any kind of damage. 15. I agree to pay the damages without any disagreement if found guilty, and my parent/s hereby give their consent for the same. 16. All rules are made to ensure discipline, safety and security of the HOSTEL, STUDENTS & the CAMPUS. Your cooperation will help us serve you better. Name of the student Signature of the Student SIMSR-Hostel/ver 5.0/ SIMSR Hostel - Vidyavihar Page 5 of 6
6 Name of the Parent Signature of the Parent Mob: Mob: -Id (student) -Id(parent) Date: Vidyavihar, MUMBAI Collage Stamp SIMSR-Hostel/ver 5.0/ SIMSR Hostel - Vidyavihar Page 6 of 6
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