FTK-Centre for Information Technology

Jamia Millia Islamia, New Delhi-25

PROFORMA FOR Wi-Fi ACCOUNT
Name ..............................................................................................................
Fathers Name.................................................................................................
Applicants category:

Student

Employee

Employee/ Student ID .....................................................................................

Course/Designation .........................................................................................

PASTE YOUR
RECENT
SELFATTESTED
PHOTOGRAPH

Faculty/ Department / Centre ..........................................................................

I-Card no I ........................................ Card valid up to .....................................
Mac Address ................................................Cyberoam ID if any ................................................
Contact no. ...................................................E-mail Id ................................................................
Local Address ............................................................................................................................
....................................................................................................................................................
Justification: ...............................................................................................................................
....................................................................................................................................................
Agreement: I hereby declare that, I am a student /Employee of Jamia Millia Islamia and I
hereby undertake that I will use the Wi-Fi facility for official/ Academic purpose only.
Signature of the Applicant
Date ..........................
Forwarded By
Head of the Dept./ Director
(Signature with Office Seal)
FOR CIT USE ONLY

Signature ..........................................

Permitted

Not Permitted

(Hony. Director)
Registration No. ................................
Login Name .......................................

Password .........................................

Note: All Fields are compulsory.

The total data transfer could not be exceeding 1 GB per month.
After attestation submit the form in concern office.