Annexure-A2 TRANSPORT APPLICATIONA FORM (FOR STUDENTS ONLY) The application form must be filled in by the student in his/her own handwriting with black/blue pen. Please read and sign. The instructions are as mentioned on the back of the form carefully. All the fields are compulsory to fill enroll for transport service of MRIIRS. Please get the from verified from the transport department after filling it completely.
/ Roll No.
Application No. GENERAL INFORMATION: Name of the student
Gender (M/F)
Father’s Name Mother’s Name Permanent Address & Phone No. Affix recent color photograph
Present Residence / Guardian Address
Tel. No.
Mobile No. Email –ID
Emergency Contact No. INSTITUTE DETAILS (Please tick (
) any one box)
MRIIRS (Manav Rachna International Institute Of Research And Studies) FET
FAHS
FCBS
FCA
FMS
FMeH
FAD
FBSS
MRU(Manav Rachna University) FoE
FoAS
FoF
BEd
FoMH
Course
Semester
TRANSPORT DETAILS (Please tick ( DELHI-1
MRDC
DELHI-2
Year
) any one box)
FARIDABAD
NOIDA
GURUGRAM
PALWAL
Mode of Payment No. Date (By DD in favour of “MRIIRS – Transport” OR Card with additional financial charges )
GHAZIABAD
Amount
Route No Bus Stop Code Boarding Point (Kindly refer to the stop code list with the transport department or at www.manavrachna.edu.in)
DECLARATION: I have gone through the transport rules and regulations of the institute, notified on the back side and I shall abide by them. I have noted that in case of non compliance of the transport rules and regulations, the bus facility may be terminated and I shall have no right to claim balance amount of bus fee. The management of MRIIRS will be exempted from any, claim / damages owing to any loss during transportation, if any, filed by the transport users.
Signature of Student
Signature of Father / Guardian
Sign. Of Dean/AO/AR/AAO
Transport Department FOR OFFICE USE ONLY
Receipt No.
Date
Amount Accountant