Form – G

(for office use only)

UNDERTAKING FORM
Student File No.:-______________________
FOR HOSTEL FACILITY
(For New Candidates) School Registration No:__________________

Hostel Registration No: _____________________

Room No: _______________Bed No: ___________

Hostel Fee:_________________________________

Important Instructions
 For applying for the hostel facility, Original Medical Certificate (format to be obtained from the Counseling and Admission Department and/or to be
downloaded from the website) is to be submitted by candidate along with other essential documents at the time of re-registration.
 No column should be left blank. Write N.A. if not applicable.
 All the details should be filled in Block
Letters
 Duly filled in Undertaking Form is to be signed by the candidate with blue/ black pen and duly countersigned by the
parent/ guardian.
Name ____________________________________________________________________________________________________________

Class __________________________________________Stream (If applicable) _______________________________________________

Permanent Address Correspondence Address (If different from permanent address)

Address __________________________________________________________ Address __________________________________________________________

__________________________________________________________________ __________________________________________________________________

Town / City _______________________________________________________ Town / City _______________________________________________________

District ___________________________________________________________ District ___________________________________________________________

State / UT _______________________________________________________ State / UT _______________________________________________________

Country ____________________________Pin/Zip ________________________ Country ____________________________Pin/Zip ________________________

Telephone No: FATHER Telephone No: MOTHER

Residence (with STD Code)__________________________________________ Residence (with STD Code)__________________________________________

Office (with STD Code)______________________________________________ Office (with STD Code)______________________________________________

Mobile ___________________________________________________________ Mobile ___________________________________________________________

E-mail ID _________________________________________________________ E-mail ID _________________________________________________________

Self-Mobile_______________________________________________________ Self-E-mail ID: ____________________________________________________

UNDERTAKING FOR HOSTEL FACILITY BY THE STUDENT

I, ___________________________________________________________S/o/ D/o _________________________________________________do hereby solemnly

affirm and undertake that:
1. I shall abide by all the provisions of the Hanifa School and Govt. Act, Statutes, Ordinances, Regulations, Rules, Orders, Instructions, Information, Guidelines,
Manuals, Code, Circulars etc. in force and as amended from time to time (hereinafter jointly referred to as “the Provisions”) of and/or framed by the
Government, Institutions, sponsoring Trust and their Institutes, Schools, Departments, Divisions, Centers, other constituent units, establishments and facilities
including hostels, transportation etc. and concerned authorities, officers, assigns and employees ( hereinafter referred to as “the Management”). The
Management will be at 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 Institution, or any act which is detrimental to the interest of the Institution. The Management, in
such case, may discontinue my stay in the Institution and I shall not be entitled for any refund of admission fee, hostel fee, bus fee and any other fee / charges paid
to the Institution and I shall also 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 (one
year), I shall pay the hostel charges for the full academic year.
3. I shall not be entitled to claim my admission to the hostel as a matter of right.
4. 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 Institution. If I am found guilty of indulging into a despicable act of ragging intentionally or unintentionally, the Management may take
appropriate disciplinary action (including rustication/expulsion from the hostel and/or the Institution) against me and further legal action as per law of land.
5. I shall not possess, use or deal with any kind of intoxicating material including alcohol, drugs of any kind, gutka, tobacco, cigarettes, chewing gums or any other
sedative materials, vulgar/offensive/porn/gory audio-visual, graphic/pictorial content or literature viz. vulgar songs/videos/pictures/books/jokes and/or contraband
goods/items as determined the Government of India and on being found guilty, the Institution may take any disciplinary action(s), including rustication/expulsion,
against me including a legal action as deemed fit.
6. I shall not use abusive/vulgar language and/or indulge in any such physical actions (individually or in a group) that may consist of minor or serious misconduct
intentionally or unintentionally and may be found inappropriate/immoral/banned in accordance to the norms of acceptable socio-cultural behavior and which may
be categorized as a Punishable Offence/Juvenile Crime under the Indian Penal Code and on being found guilty, the Institution may take any disciplinary action(s),
including rustication/expulsion, against me including a legal action as deemed fit. In case, I find an instance of the same I will inform the concerned authorities
immediately.
7. I shall not possess, use or abet the use of any kind of weapons including sticks, rods, explosives, firework or any such material and on being found guilty, the
Institution may take any disciplinary action(s), including rustication/expulsion, against me including a legal action as deemed fit.
8. I shall be liable to pay for any damage caused by me to the property of the Institution either alone or jointly with others and face disciplinary action.
9. 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 Institution and any other legal action under the law of land. The
Management shall not be responsible for the same.
10. I shall not profess/preach/practise and/or uphold any orthodox views of faith/worship and shall never use the hostel/school premises for any such kind of activities.
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
Institution on my treatment for any sickness or personal injury due to any reason during the course of my study at the Institution.
12. I shall myself take precautions against insect-bites, dog-bites, snake-bites, animal-bites, plant-bites and maintain hygiene and proper care to ensure safety from any
infectious/contagious diseases and shall carry the first –aid kits every time and the School/Hostel Authorities or Management Personnel shall not be liable for such
infections and diseases.
13. 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 Institution shall not be responsible for any kind of compensation.
14. I understand that 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 Institution shall not be responsible for any type of compensation.
15. I will have to vacate the hostel in case of any requirement of the Institution for some specific period for any reasons including accommodating guests, delegates,
participants of any event, for maintenance work etc.
16. I shall not collect any money from any student(s), employee(s) or other person(s) for any purpose including donations, contributions/gathering without the written
approval of the Institution.
17. The Management 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.
18. The Management has the full authority for the inspection of the room, bags, almirahs or any of my personal belongings at any time.
19. I understand that hostel, allotted at the time of admission or otherwise, may be shifted to other hostel, at any time and the allotted room, floor and other facilities in
the hostel may also be changed at any time, as decided by The Management.
20. I shall not allow any unauthorized person to enter or stay/live in my room.
21. I shall not misuse electricity and resources by using electrical gadgets like irons, heaters, audio players, juicers etc. and other electronic/battery/fuel powered
(gas/petrol/diesel/kerosene etc.) devices and will not waste food, water and other important resources for fun or owing to casual behavior.
22. I understand that the hostel fee does not include the electricity charges/amount and I shall be liable to pay the electricity charges/amount separately in addition to
the hostel fee as decided by The Management.
23. I understand that the hot water supply shall be available in winter only for fixed timings in the washrooms, as decided by The Management.
24. If I absent myself from the Institution without permission, I am liable for disciplinary action, which may amount to my rustication/expulsion from the Institution.
25. If declared ineligible for appearing in any examination of the School/Board, on account of shortage of attendance or any other reason whatsoever or if ordered by
the Institution 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 Management.
26. All type of charges and fee as charged by the Institution are subject to revision from time to time.
27. For any unforeseen issues arising, that is not covered by this Undertaking, or in respect of all the matters, not expressly provided herein, the Institution may take
an appropriate decision that shall be final and binding on me and all other concerned.
28. I am giving this undertaking with full understanding 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 and other information 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 Management,
notwithstanding legal action under the law of the land. In such case, the hostel fee and other charges deposited by me shall be forfeited.
29. The Management reserves the right to frame, amend, revoke or repeal the Provisions including hostel timings and that will be effective and binding on all the
concerned, as decided by the Management from time to time.
30. The Courts in Borsad shall have the jurisdiction over all disputes arising out of or in respect of matters relating to students including admission, academics,
administration, hostel, transport and all other matters.

Place: …………………………… ………………………….

Date: …………………………… (Signature of 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, AND as per Act of Govt. of AP w.r.t
ragging, ragging is a cognizable criminal offence and is strictly prohibited. If any incident of ragging comes to the notice of the University, the concerned
student shall be given liberty to explain and if his explanation is not found satisfactory, the University would expel him from the University.

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 Undertaking for Hostel Facility with full
understanding and my express permission; and I shall hold myself responsible for his/her good conduct and behaviour as a student of the Hanifa School.
2. 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.
3. 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.
4. 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 Management of Hanifa School, 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 Hanifa
School, 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 Hanifa School).

Place: …………………………… ………………………….

Date: …………………………… (Signature of the Student)

(To be countersigned by the Parent/Guardian)

………………………………………
Place: …………………………… (Full signature of the Parent/Guardian)

Name………………………………………………

Relationship with the Student …………………….

For office use only

Allotment Status: Confirmed/Rejected/Any Other___________________________________________________________________________________

Name of the Hostel: ________________________________________________________ Type: ____________________________________________

Total Hostel Fee (Annually): _________________________________________________ Fee Paid: __________________________________________

Balance (if any): _____________________________________________________________________________________________________________

Date: …………………………. …………………………….

(Signature of dealing official)