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- Name Of
Inmate
: _________________________________________
- (a) Father's
name
: _________________________________________
(b) Permanent
Address
: _________________________________________
(c) Telephone
Number
: _________________________________________
- (a) Guardian's
Name
: _________________________________________
(b) Permanent
Address
: _________________________________________
(c) Telephone
Number
: _________________________________________
- Name Address & telephone
No.
: _________________________________________
of Local Guardian, if
any.
: _________________________________________
- Name of
College/Institute/School
: _________________________________________
- Standard
: _________________________________________
- Address of
Institution/College/School
: _________________________________________
- Name Address & Telephone No. of
the
: _________________________________________
person nominated to visit the inmate
other
: _________________________________________
than
Parents/Guardian.
: _________________________________________
- Telephone/Fax/E-Mail to be used in the event
of
: _________________________________________
important information regarding the health, Behavior
: _________________________________________
and conduct of the
inmate
: _________________________________________
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DECLARATION
I/we hereby declare that I/we have fully understood the terms and
conditions as detailed in the prospectus and hereby agree to fully abide
by them. I/we further undertake that my/our ward shall observe the good
conduct, noble manners and follow the instructions in the right earnest
issued by the Management.
Dated
:
Signature
(Inmate)
Signature (Parent/Guardian)
Place :
