IAEER'S
PUNE INSTITUTE OF BUSINESS MANAGEMENT
(APPROVED BY AICTE, MINISTRY OF HRD, GOVT. OF INDIA &
AFFILIATED TO UNIVERSITY OF PUNE)
Pass port
size photograph of the
APPLICATION FORM FOR HOSTEL ACCOMMODATION student to be pasted
(BATCH 2019-2021)
Date of joining the Institute ______________
Important instructions:
Read the instructions before filling the form.
No column should be left blank. Write N.A. if not applicable.
All the details should be filled in Block Letters.
Application form must be filled in, signed by the student in his / her own handwriting, and duly countersigned by the
parent / guardian.
1. Name (block letters) _______________________________________________________________________________________________________
2. Gender: Male/Female _______________ Date of Birth: _________/_________/________________ Age __________
(DD/MM/YY)
4. Mobile No. : __________________________________ Email ID. ____________________________________________________________________
3. Father’s Name: _______________________________________________________________________ Occupation: ______________________
4. Mother’s Name: _______________________________________________________________________ Occupation: ______________________
5. Permanent Address:
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
6. Correspondence Address:
(If different from permanent address)
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________
__________________________ __________________________
Signature of the Parent’s Signature of the Student
(For Office Use Only)
Course Admitted ________________ Hostel Name: ____________________ Hostel Address: _____________________________________ ___
(Room No: ________ Seater: ____________)
Name of the Hostel Representative: - Signature
UNDERTAKING BY THE APPLICANT
I, ____________________________________________S/o/ D/o ___________________________________do hereby solemnly affirm and undertake that:
1. I shall abide by all the provisions of the Rules & Regulations, Orders, Instructions, Guidelines, Manuals, Codes, etc.(by whatever name it may be
called) of the IAEER’S Trust (herein referred as Trust),the concerned Institute PUNE INSTITUTE OF BUSINESS MANAGEMENT (herein
referred as Institute) , related to the hostel accommodation, in force and as amended from time to time. The Trust/Institute/University, as the
case may be, will be at the liberty to impose any penalty or any disciplinary action(s) on me being found guilty of, any sort of misconduct or
indiscipline or disobedience or malpractice within or outside the precincts of the hostel, or any act which is detrimental to the interest of the
Trust/Institute/University. The Trust/Institute/University, in such case, may discontinue my course of study and I shall not be entitled for any
refund of admission fee, hostel fee, bus fee or any other fee/ charges paid to the Trust/Institute/University and I shall be liable to pay the
pending fee, dues, penalty ,etc.
2. I shall retain the hostel accommodation for the full academic session (i.e. one year) and if due to any reason I leave the hostel during the
academic session, I shall pay the hostel charges for full academic year.
3. I shall faithfully carry out the instructions issued by the hostel authorities from time to time.
4. The Trust/Institute/University is entitled to provide me the residential accommodation, at its own or through any other arrangement, in and
outside the campus, as may be decided by the Trust/Institute/University.
5. I shall not be entitled to claim my admission to the hostel as a matter of right.
6. I am aware that ragging is a criminal offence and is strictly prohibited. I shall not indulge directly or indirectly in any act of ragging on the
campus, in hostels or outside the campus of the Institute/University. If I indulge in ragging, the Trust/Institute/University may take
appropriate disciplinary action (including rustication/expulsion from the hostel and/or the Institute/University) against me and further legal
action as per law of land.
7. I shall not possess, use or deal with any kind of intoxicating material including alcohol, drugs of any kind, gutka, tobacco, cigarettes or any
other sedative materials. If I fail to do so, the Trust/Institute/University may take any disciplinary action(s), including rustication/expulsion
from the hostel and/or the Institute/University, against me.
8. I shall not possess, use or abet the use of any kind of weapons including sticks, rods, explosives, firework or any such material. If I fail to do so,
the Trust/Institute/University may take any disciplinary action(s), including rustication/expulsion from the hostel and/or the
Institute/University, against me.
9. I shall be liable to pay for any damage caused by me to the property of the hostel and/or the Trust/Institute/University either alone or jointly
with others and face disciplinary action.
10. I do not have the tendency, and shall not make any attempt, to commit suicide or abetting or inciting any other person to commit suicide or
anything unwarranted and /or prohibited by law or otherwise and shall not give any sort of threats to commit suicide or likewise and or being
found guilty of the aforesaid action, I myself shall be responsible for any consequences under law and the expulsion/rustication from the
Hostel and/or Institute/University and any other legal action under the law of land. The authorities of the Trust/Institute/University and /or
the hostel or any employee or person of the Trust/Institute/University and/or the hostel shall not be responsible for the same.
11. I am medically fit and have no communicable and serious diseases like that of fits, any sort of attacks or any other I shall pay for any
expenditure incurred by the Trust/Institute/University on my treatment for any sickness or personal injury due to any reason during the
course of my study at the University/ Institute.
12. I shall not keep excess cash and valuables with in the hostel and in case of any loss or damage of cash or valuables, including mobile phones,
PC, laptop or any other personal belongings, the Trust/Institute/University and the hostel authorities shall not be responsible for any kind of
compensation.
13. Parking of vehicles (if allowed) in the hostel will be at my own risk and in case of any loss of personal belongings; loss or damage to the vehicle
or parts /accessories of the vehicles, the Trust/Institute/University and the hostel authorities shall not be responsible for any type of
compensation.
14. I will have to vacate the hostel in case of any requirement of the Trust/Institute/University and/or the hostel authorities for some specific
period for any reasons including accommodating guests, delegates, participants of any event, for maintenance work etc.
15. I shall not collect any money from any student or any employee for any purpose including donations, contributions/gathering without the
written approval of the Trust/Institute/University.
16. The Trust/Institute/University has the full authority to call/send for official/academic purposes any time even during holidays or for early or
delayed stays even during nights.
17. The Trust/Institute/University and the hostel authorities have the full authority for the inspection of the room, bags, admirals or any of my
personal belongings at any time.
18. I understand that hostel, allotted at the time of admission or otherwise, may be shifted to another place, at any time, in or outside the campus
and the allotted room, floor and other facilities in the hostel may also be changed at any time, as decided by the concerned authorities.
19. I shall not allow any unauthorized person to enter or stay in my room.
20. I shall myself take precautions against insect-bites , dog-bites, snake-bites, animal-bites, plant-bites and such other infections and diseases and
shall carry the first –aid kits every time and the Trust/Institute/University and the hostel authorities shall not be liable for such infections and
diseases.
21. I shall not misuse electricity by using electrical gadgets like irons, heaters, audio players, juicers etc. Electricity bill is exempted till Rs. 400.
Extra electricity bill will be charged from per student.
22. I understand that I shall be allotted with fixed units of electricity for my room and in case of excess usage of the electricity i.e. more than the
allotted units either alone or jointly with others, I shall be liable to pay the amount/charges for the excess units as decided by the
Trust/Institute/University and the concerned authorities.
23. I understand that the hot water supply shall be available for fixed timings in the washrooms, as decided by the Trust/Institute/University and
the hostel authorities.
24. If I absent myself from the Institute/University or hostel without permission, I am liable for disciplinary action, which may amount to my
rustication/expulsion from hostel and/or the University/Institute.
25. If declared ineligible for appearing in any examination of the Institute/University, on account of shortage of attendance or any other reason
whatsoever or if ordered by the Institute/University authorities at any time, I shall vacate the hostel immediately. Readmission to hostel in the
forthcoming term/semester may be allowed only at the sole discretion of the Institute/University/Trust.
26. All type of charges and fee as charged by the Trust/Institute/University are subject to revision from time to time.
27. The Trust/Institute/University and the hostel authorities have the full authority to amend the hostel rules & regulations including hostel
timings from time to time.
28. For any unforeseen issues arising, that is not covered by this Undertaking, or in respect of all the matters, not expressly provided herein, the
Trust/Institute/University and the concerned authorities (whichever may be applicable) may take an appropriate decision that shall be final
and binding on all the concerned.
29. I have carefully read the Application Form for Hostel Accommodation and related details and state that the information given by me above are
true and complete to the best of my knowledge and belief and the certificates/ documents submitted by me are genuine and nothing has been
concealed / suppressed. I understand that if any of the statements made by me above is found incorrect, I shall be liable to such disciplinary
action(s) and/ or penalty as may be decided by the Trust/Institute/University, notwithstanding legal action under the law of the land. In such
case, the fee deposited by me shall be forfeited..
………………………………………..
Place: - (Full Signature of the Student)
UNDERTAKING TO BE SIGNED BY THE PARENT / GUARDIAN
I, ____________________________________________________S/o /D/o ____________________________do hereby solemnly affirms and
undertake that:
1. My son/daughter/ ward, ________________________________________ has submitted this Application Form for Hostel
Accommodation with my express permission and that I shall hold myself responsible for his/her good conduct
and behavior as a student of the University/Institute and adherence to all the provisions of the Rules &
Regulations, Orders, Instructions, Guidelines, Manuals, Codes, etc. (by whatever name it may be called) of the
IAEER’S Trust, the concerned Institute and the PUNE INSTITUTE OF BUSINESS MANAGEMENT (if applicable),
related to the hostel accommodation, in force and as amended from time to time.
2.
3. I shall hold myself responsible for payment of all his/her fee and other charges during his/her stay in the hostel
and pending dues, penalty, etc.
4. I shall, myself, be responsible for any sort of liability arising and any civil or criminal case lying against my
son/daughter/ward during the course of study.
5. I endorse the undertaking given by my son/daughter /ward.
Place: ………..……………………………
…………………..……………………………………………
{Full signature of the Parent/Guardian)
Name……………………………………………………….
Relationship with the Student……………………
INDEMNIFICATION
I hereby indemnify the PUNE INSTITUTE OF BUSINESS MANAGEMENT, against all rights and claims by myself, my
dependants, next of kin or other legal representatives for compensation for damages or disability arising out of
personal injury or death due to any reason during the course of my study (on campus or off campus) in the
Institute/University including during study, industrial visits, trainings, tours, conduct of practical, working in
laboratories or workshops, stay in hostel, traveling in the transport or otherwise (within or outside the precincts of
the Institute/University).
Place: ………….……………………….…
…………………..……………………………………………
(Full Signature of the Student)
(To be countersigned by the Parent/Guardian)
…………………..……………………………………………
Place: ………….………………………. (Full Signature of Parent/Guardian)
Name………………………………….……………………
Relationship with the Student ……………………
RAGGING IS STRICTLY PROHIBITED
As per the Supreme Court judgment in Vishwa Jagriti Mission v. Central Government and Others (2001) 6 SCC 577,
ragging is a cognizable criminal offence and is strictly prohibited. Any body found indulging in any act of ragging
on the campus, in hostels or outside will be severely punished and rusticated/expelled from the
Institute/University without any notice and further legal action will be taken as per law of the land.
