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SVKM’s

(Declared as Deemed-to-be University under section 3 of the UGC Act, 1956) JVPD Scheme. Vile Parle (W), Mumbai-400 056, India. • Tel.: +91-22- 2613 4577 / 4235 5555 Fax: +91-22-26114512 • Email: nmims@nmims.edu • Visit us at: www.nmims.edu

HOSTEL APPLICATION FORM

(To be filled in by the applicant in his/her own handwriting clearly and carefully) (Before submission, Pl. Confirm the availability from NMIMS) Admission (Final) Payment Receipt Number _____________ (For first year students)

Hostel Allotted : Flat / Room No.: Bed No. :

A) MUMBAI CAMPUS MKM SANGHVI GIRLS HOSTEL (Only for MBA) G. R. JANI BOYS HOSTEL (Only for MBA) RESIDENTIAL FLATS (GIRLS) RESIDENTIAL FLATS (BOYS) B) SHIRPUR CAMPUS BOYS HOSTEL GIRLS HOSTEL Sir,

Recent Passport size colour Photo

The Director (Admin) SVKM’s NMIMS Mumbai 400056.

I wish to apply for providing accommodation in any Hostel/Residential Flats (converted into hostel) (preference ticked as above) managed by SVKM’s NMIMS for the academic year _________________________________________________ I hereby agree that I have read and will abide by the Rules and Regulations of the hostel in force from time to time. I furnish the following particulars : (Strike out whichever is not applicable) PERSONAL DATA : 1) Full Name (with Surname) ____________________________________________________________

____________ 2) Residential Address ____________________________________________________________

_______________ ____________________________________________________________

______(Email)___________________________ Tel. No. (M) _______________________________________________ (R)_________________________________ 3) Date of Birth ___________________________ 4) Nationality _____________________________

I declare that the information given above is true to the best of my knowledge. I agree that if any information furnished above found incorrect my admission is liable to be cancelled.

Date:

Signature of the...