HAMDARD UNIVERSITY

(Jamia Hamdard)
HAMDARD NAGAR, NEW DELHI - 110062
TION FORM FOR ADMISSIONS
APPLICATION
APPLICA
DIRECT ORA
DIRECTORA TE OF OPEN AND DIST
ORATE ANCE LEARNING
DISTANCE
(FOR DISTANCE EDUCATION PROGRAMME)

IMPOR
IMPORT TANT INSTRUCTIONS: FORM NUMBER :
1. Read the PROSPECTUS carefully before filling in the form.
2. Please fill in all the entries in CAPITAL LETTERS using a BALL POINT PEN only
3. DO NOT STAMPLE/PIN ANY DOCUMENT WITH THIS FORM. (Use Clip)
4. Application form with incomplete information and without prescribed fee will not be processed.
5. Write in CAPITAL LETTERS only within the box without touching the lines as shown in the Sample below. (For office use)

0 1 2 3 4 5 6 7 8 9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Academic Year

Programme of Study (Write programme Code in the boxes as given in Prospectus)

1. Programme Code 2. Processing Fee Enclosed 3. Study Centre Choice 4. Employed?

Rs. (See Prospectus for Code) A1 = Employed

B2 = Unemployed

5. Personal Details

Name (Use CAPITAL LETTERS only

CAPITAL only.. Leave a blank box between First, Middle & Last Names)

Date of Birth Region SC/ST Gender State of Domicile Area

1. RURAL
2. Urban

DAY
DAY MONTH YEAR (See Prospectus for Codes fo rilling in the boxes shown above.)

Father
Father’’s Name (Use CAPITAL LETTERS only
CAPITAL only.. Leave a blank box between First, Middle & Last Names)

Country Name Permanent Address PIN Code

6. Qualifying Exam. Details (See prospectus for codes)

Qualifying Board/University Year of Passing

Percentage
Exam Code Code / Appearing

7. Photograph 8. Write name & Complete Mailing Address with

Black Ball Point Pen

Name :

C/o

Paste your
photograph within
this box Phone No. :
DO NOT STAPLE 9. Candidate’s Signature
Candidate’s
E-mail ID:

PIN CODE
10. Details of Examinations Passed

Name of School / Board/ Year of Percentage

Examination Subjects
College & Place University Passing or Grade

High School
(Class X)

+2/Intermediate

Graduation I year
(Write the name
II year
of the degree)
III year

IV year

Aggregate

Post-Graduation

Fazilat

Any Other

11. Mother
Mother’’s Name _________________________________________________________________________________________

12. Permanent Address ________________________________________________________________________________

________________________________________________________________________________

DISTRICT
________________________________________________________________________________

STATE PIN CODE

________________________________________________________________________________

COUNTRY
________________________________________________________________________________

13. Are you a son/daughter/spouse of Jamia Hamdard employe? YES / NO

(If yes, a certificate from the Registrar showing the relationship should be submitted in
the office of the Director
office Director,, Directorate of Open and Distance Learning personally.)
personally.)

14. Details of Draft

Draft Number & Date Amount Drawee Bank

DECLARATION BY THE APPLICANT

ECLARATION
I ....................................................................... S/o or D/o ....................................................................... declare that the statements given in this
application form are true to the best of my knowledge. I understand that if any of the statements are found wrong, my admission will
stand cancelled. If admitted, I will abide by the rules of regulations in force in jamia Hamdard and as amended from time to time and
pay the prescribed fees.

Date : Signature : .......................................................................

Name : .......................................................................