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Details of Admission Test Fee/ Processing Charges Page 1of 3

DD/C.R. No. Amount


Course Name with date (For Office use only)
(Rs.)

ALIGARH MUSLIM UNIVERSITY, ALIGARH Affix


Session: 2010-11 (Do not staple)
Application Form for Admission Self Attested
Recent
Instructions:
1. Read the Guide to Admissions 2010-2011 carefully before filling in this Application Form Photograph of
2. The Guide to Admissions and other instructions are available on our website www.amucontrollerexams.com
size 2.5cm. x 3 cm.
3. Candidate should fill the Application Form in his/her own hand writing USING CAPITAL LETTERS.
4. Aligarh shall be the Test Centre for all courses

(1) Course Applied For (2) Faculty

(3) Tick any one for Class XI (Science)/Diploma Engg. combined Admission Test Only
(Candidates should mention their preference for combinations/branches in column No. 4)
XI (Science) only Diploma Engg. only XI (Science) & Diploma Engg. both

(4) Order of Preference of Branches of Study/Specialization/Course alongwith Course Code(s)


i) _____________ ii) _____________ iii) _____________

iv) _____________ v) _____________ vi) _____________

vii) _____________ viii) _____________ ix) _____________


(5) Indicate preferences for Two Admission Test Centres, write 1 & 2 (Applicable to MBBS/BDS, B.Tech., Class XI/Dip. in Engg.)
XI/Diploma in Engg.*
MBBS/BDS, B. TECH. Aligarh Lucknow Bhopal Hyderabad Kolkata Kozhikode
*(For Class XI/Dip. in Engg. there are only two Admission Test Centres viz. Aligarh & Lucknow)

(6) Status (7a) Enrolment No. (7b) Hall


(Internal/External) (For the candidates enrolled at AMU, Aligarh) (Code only)

(8) Name of the Candidate (Mr ./Ms.)


(As in HS/SS Certificate)

Day Month Year


(9) Date of Birth (10) Gender (M/F) (11) Nationality

(12) Father’s Name _____________________________________ (13) Mother’s Name ____________________________


(14) Correspondence Address

District ____________________________ ____________________ State Pin


(Code only)
Tel./Mobile No.______________________________________ Email ______________________________________

(15) Special Category Code i) ii) iii) (16) Gate Score / Passing year
(Attach Attested Certificate) (Applicable to M.Tech. courses only)

(17) Is Hostel Accommodation Required (After admission)? (Y/N)


(18) Details of Qualifying Examination (*Write RA if result is not declared)
Year of
Board/ Maximum
Examination Roll No. Passing/ Marks Remarks*
University Marks
Appearing

Subject
Marks Obt./Max
(19) Test Subject (Studied at B.A./B.Sc./B.Com./B.Th.)
(Applicable to B.Ed. only -- Attach Marksheets of I, II & III rd yr .)
Subject Name Subject Code
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(20) Details of Professional Experience after Passing the Diploma in Engg. Examination
(Attach documentary proof for B.E. (Evening) only)
Name of the Organization/ Employer Period of Experience Remarks
Position held
From To

(21) Declaration
I, hereby solemnly affirm that I have gone through the Guide to Admissions and its supplement. I have neither been involved in any
criminal case nor any criminal case is pending against me in any court of law. I have not been debarred/rusticated by the institution
last attended/presently attending. I, _________________________________, hereby solemnly declare on oath that the entries made
by me in the above columns are true to the best of my knowledge and belief and if at any time, the entries are found incorrect, the
admission may outrightly be cancelled and disciplinary action may be initiated against me.

Date: ________________ __________________________ _____________________________


Thumb impression of the candidate, Male (LTI), Female (RTI) Signature of the candidate

(22) Information for statistical purpose


(a) Religion______________ (b) SC/ST/OBC______________ (c) Rural/Urban_____________________
(d) Father’s/Guardian’s monthly income Rs. ____________________ (e) Occupation______________________
(23) CHECK LIST: Following enclosures are attached with this Application Form.
Note: Original certificates/documents not to be attached with the Application Form in any case.
For Office Use 1. Crossed Demand Draft/Cash Receipt For Office use
2. Self attested copy of HS/SSC in support of date of birth V erified Original Documents.
3. Self attested copies of Marksheets/Grade sheets of qualifying The candidate is eligible for
admission to ______________
Examination
Remarks _________________
4. __________________________________________________ _________________________
5. __________________________________________________ _________________________
6. __________________________________________________ V erifying Officer __________
Signature of
7. __________________________________________________ Dept. of __________________
Scrutiny Officer
Date _____________________
(24) Candidate is required to write in CAPITAL LETTERS his/her name and complete postal address for correspondence.

Name ____________________________________ Name ____________________________________


Address __________________________________ Address __________________________________
_________________________________________ _________________________________________
District ________________ State _____________ District ________________ State _____________
Pin Code Pin Code
Tel./Mobile No. ____________________________ Tel./Mobile No. ____________________________

Name ____________________________________ Name ____________________________________


Address __________________________________ Address __________________________________
_________________________________________ _________________________________________
District ________________ State _____________ District ________________ State _____________
Pin Code Pin Code
Tel./Mobile No. ____________________________ Tel./Mobile No. ____________________________
ALIGARH MUSLIM UNIVERSITY, ALIGARH Page 3 of 3
(2) R. No.: ______________________
For Office Use
Affix
(Do not staple)
INDEX SLIP Non-attested
Photograph
(1) Details of Adm. Test Fee/Process. Charges Session: 2010-11 of size
Course Applied for _____________________________ 2.5cm. x 3 cm.
Photograph must
DD/Cash Receipt No. Dated Amount not exceed this
(Rs.) box.

(3) Name of the Candidate

(4) Father’s Name

(5) Mother’s Name

(6) Gender (M/F)

__________________________
Date _______________ Signature of the Candidate

Fold from here Fold from here

ALIGARH MUSLIM UNIVERSITY, ALIGARH


Scan Slip, 2010-2011

Course Applied for _________________________________ Affix


(Do not staple)
Non-attested
Name ________________________________________ Photograph
Candidate’s Thumb Impression of size
Male(LTI), Female(RTI)
Father’s Name _________________________________ 2.5cm. x 3 cm.
Photograph must
Correspondence Address ________________________ not exceed this
box.
_____________________________________________
_____________________________________________
Specimen Signature of the District __________________ State________________
Candidate Pin Code
Date ______________ For Office use
Fold from here Fold from here

ALIGARH MUSLIM UNIVERSITY Postage stamp(s)


of Rs. 6/- must
be affixed here
Your application for admission to
ACKNOWLEDGEMENT SLIP
_____________________________
(mention course) INSTRUCTIONS To
Class / Course for 2010-2011 has (1) Write your complete mailing address on the ______________________________________
right hand side.
been received under R. No.: (2) Keep this card with you as a proof of
submitting your Application Form. ______________________________________
_________________________ (3) IMPORTANT: For reference always quote
R.No. in all your correspondence/queries. ______________________________________

______________________________________
Dealing Assistant DEPUTY CONTROLLER Pin Code
Date ____________ (Admissions)
Affix
(Do not staple)
Self Attested
ALIGARH MUSLIM UNIVERSITY, ALIGARH Recent
Photograph of
Session: 2010-11
size 2.5cm. x 3 cm.
PROFORMA FOR OUTSTANDING DEBATER/SPORTSPERSON
Instructions:
1. This proforma is to be filled in only if the candidate desirous of consideration under special categories of Debater/Sportsperson
2. Candidate is only considered eligible if he/she claims the special category on the main Application Form
3. Candidate must read the Guide to Admission before filling in this proforma

(1) Course Applied For (2) Subject

(3) Tick only one category (4) Name of the Game


(Write any one Game only -- Applicable to outstanding Sportsperson only)
SPORTSPERSON DEBATER

(5) Title of the Event with Highest /Award won

(6) Name of the Candidate (Mr ./Ms.)


(As in HS/SS Certificate)

(7) Status (8) Date of birth _____/_____/________


(9) Father’s Name _________________________________ (10) Mother’s Name _____________________________

(11) Correspondence Address

District ____________________________ ____________________ State Pin


(Code only)
(12) Qualifying Year of Passing/ Board/ Marks Maximum
Roll No. Remarks
Examination Appearing University Obtained Marks

(13) Declaration
I hereby solemnly affirm that the facts stated in the proforma are true to the best of my knowledge and belief and no
disciplinary action has been taken against me by any University/College/Sports Authority.
I also undertake that in case I am offered admission under nomination category of “Outstanding Sportsperson/Debater”,
I shall participate in Sports/Debating activities regularly in the University, failing which my admission may be cancelled
at any stage and I will have no claim for my admission in any Court of Law.

Date: Signature of the candidate


(14) Candidate is required to write in CAPITAL LETTERS his/her name and complete postal address for correspondence.

Name ____________________________________ Name ____________________________________

Address __________________________________ Address __________________________________

_________________________________________ _________________________________________

District ________________ State _____________ District ________________ State _____________

Pin Code Pin Code

Tel./Mobile No. ____________________________ Tel./Mobile No. ____________________________

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