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AMITY SCHOOL OF DISTANCE LEARNING

PARTICULARS FOR ISSUE OF STUDENTS’IDENTITY CARD

---------------------------------------------------------------------------------------Note: 1) Please fill up particular’s in duplicate to CAPITAL LETTERS only. 2) Please submit one copy of your recent passport size colored photograph.

Full Name: Name of Parent/Guardian: Mailing Address: Program Admitted to: Roll Number: Mode: DL/C Category: Date of Birth

……………………………………………… ………………………………………………. ………………………………………………. ………………………………………………. ………………………………………………. Books: Y/N General/Concessional :
DD MM YY

Blood Group Contact No. in case of Emergency: Office: Family: Specimen Signature:

:

(Please sign within the box in black ink only)

For office use only Verified by : Designation: ( Seal of Office) Date of Issue Date of expiry:

: :

500 4. to be printed on reverse). Produce when asked for while entering the campus.(Instructions. Surrender on completion of program . This identity Card is the property of Amity University. appearance in end term examinations 3. 1. 2. Unauthorized use will entail cancellation 5. When lost lodge FIR with nearest Police Station promptly and produce for issue of fresh Identity Card on payment of Rs. availing library facility.