Indian Institute of Technology Hyderabad
Kandi, Sangareddy - 502285
Telangana, INDIA
Phone: 040-2301 6131 Email: hostel@[Link]
Hostel Accommodation Form
[Link] Name: _____________________________________________
One Recent
[Link] Address:_________________________________________
Passport Size
Photo to be fixed
City:_______________State:____________________
and one to be
Pin:________________Ph:______________________ given along with
the form
Mob:_____________________________
Email ID:__________________________
[Link] of Birth (DD:MM:YY):_____________ [Link]:____________________
[Link] (male/female):____________ 6. Blood Group:__________
[Link] Qualification:________________ [Link] disability (if any):_____________
[Link] of arrival:_______________ 10. Course & Department:______________
Family Details (all in block letters)
[Link] / Guardian Name:_____________________ 2. Occupation:__________________
[Link]:___________________________________________________
City:__________________ State____________________
Pin:___________________ Ph:____________________Mob:________________
Email ID:_________________________
[Link] of local Guardian (if any):_________________________
[Link] of Local Guardian with Ph/Mob No:______________________________
_________________________________________________________________________
I hereby declare that the information given above is true to the best of my knowledge
and nothing has been concealed thereof.
Place:_______________ Date:_________________ Signature:____________________
FOR OFFICE USE ONLY
Hostel Allotted: Yes/No Allotted Room No._________________
Remark if any:
Signature of warden
Hostel Office
Indian Institute of Technology Hyderabad
Kandi, Sangareddy - 502285
Telangana, INDIA
Phone: 040-2301 6131, Email: hostel@[Link]
Occupation Report
Name of the Student: Date:
Roll No. :
Programme:
Room No. :
SI. No. Name of the item Quantity
1. Steel Cot / Wooden cot One
2. Godrej Study Table with key One
3. Godrej Chair One
4. Hanger rod One
5. Curtain rods One
Received the above mentioned items.
Also, I understand that I am jointly responsible with my fellow student roommates for the
following common items in the room and for the up keep of the premises. At the time
leaving the hostel accommodation I will submit No-Dues certificate from concerned
faculty.
1. Ceiling Fan 1 No.
2. Tube Light sets 1 No./ CFL 1 No.
3. 15 ampere Socket 2 Nos. /3 Nos.
4. Switches 6 Nos.
5. Fan Regulator.
6. Lan port
Signature of the Student Hostel Staff
Date:
Student Declaration
1. I agree to abide by the rules and regulations of the institute.
2. I will also by the modification in the rules and regulations.
3. I am aware of that I am liable for disciplinary action for any of the rules and regulations of the
institute.
4. I will not indulge in ragging of students.
5. I will not indulge in any activities which may cause disturbance in the institute.
6. I will maintain the dignity and sanctity of the institute.
7. I will not keep unauthorized guests in my room.
8. I will settle all my dues in time.
9. I will not consume alcohol or any intoxicating substance in the hostel premises.
10. I will be fully and solely responsible for my acts within the institute and outside the IITH
premises.
11. I hereby agree that I will not cause any damage to the hostel property; I accept that failure on
my part to abide by this policy may lead to necessary disciplinary action.
12. I will not participate in any activity which has a tendency to disturb peace and orderly life on
campus.
Signature of the student:……………………. signature of parent:.................................
Date:.....................
Place:……………
