Date: Sep 24, 2019 Application Ref. No.

: JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/6040

Jamia Boys' Hostel

Application Form for Jamia Boys Hostel New Admission (2019-20)

Personal Information

Registration No/ Enrollment No 18-03883

Name of the Student ATAUR RAHMAN HASHMI
Category PH
Father's Name IQBAL AHMAD HASHMI
Mobile No of Father 9415454468
Date of Birth 07/01/1997
E-mail id of Father
Mother's Name SURAIYA HASHMI
Mother's Mobile Number
Guardian's Name IQBAL AHMAD HASHMI
Guardian's Mobile Number 9415454468
Student Id 20185703
Course MBA (FULL TIME) PROGRAMME - M55
Year/Semester III-SEMESTER
Faculty CENTRE FOR MANAGEMENT STUDIES
Department/ Centre CENTRE FOR MANAGEMENT STUDIES
Distance from Hometown 641.7
Family Annual Income 48000
NCC -
Sports -
Seniority in University (years) 1
Are you differently abled (40%
Y
disability)
E-mail ID of Applicant ATAURHASHMI@GMAIL.COM

Permanent Address

Permanent Address MOH RAFI NAGAR

Street MOHD RAFI NAGAR Post/Town MANKAPUR
Country INDIA State UTTAR PRADESH
City/District GONDA PIN Code/ ZIP Code 271302

Academic Record

Passed/ Marks Total Percentage

Examination Board/University Subjects Year CGPA
Awaited Obtained Marks Equivalent
X HIGH SCHOOL CBSE SCIENCE PASSED 2012 333 500 7.0 66.5
INTERMEDIA
XII CBSE COMMERCE PASSED 2014 396 500 00 79.2
TE
DR R M L A
UG B.COM UNIVERSITY COMMERCE PASSED 2017 1229 2000 00 61.45
FAIZABAD

Percentage of Marks in Qualifying Examination* 6.25 sgpa Result Awaited -

Application for Jamia Boys Hostel New Admission (2019-20) 1/3 Application Ref. No. : JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/6040
Particulars of Local Guardians

Particulars of Local Guardian

Name MOHD ANUS
Relation with the Applicant UNCLE
Address E211/9 ABUL FAZAL ENCLAVE PART 2 OKHLA 110025
Mobile No 9716438062
E-mail ID MOCMKP44@G MAIL.COM

Application for Jamia Boys Hostel New Admission (2019-20) 2/3 Application Ref. No. : JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/6040
List of Documents to be brought at the time of Interview :
1. A Demand Draft of Rs 200/- drawn in favour of The Registrar, Jamia Millia Islamia payable at New Delhi to be deposited alongwith
the Application Form in the Provost Office at the time of Interview. 2. Fee Receipt of Admission to the Course in Jamia Millia Islamia.
3. Self Attested Mark sheet of qualifying Examination. 4. Certificate of Sports (State/National Level) and NCC (A,B,C Certificate), if
applicable. 5. Self Attested copy of Voter ID/Aadhar/Passport. 6. Documents supporting Economically Weaker Section, if applicable.
7. Documents supporting Physical Disability (40%) for Persons with Disabilities (PWD) category, if applicable. 8. Three passport size
photos of the applicant. 9. Undertaking by the Applicant to follow University/ Hostel Code of Conduct*.

Note
*Guardian is a person in whose guardianship the applicant has been brought up in absence of both the natural parents due to demise
or otherwise

* Kindly bring a copy of this form along with the documents mentioned above when called for interview. The Applicant must appear for
the interview for admission in boys hostel.

* If the form is incomplete in any respect or if the candidate fails to provide any of the documents mentioned above, he will not be
allowed to appear for interview before the Interview Committee.

**click here to download Affidavit and supporting documents.https://www.jmi.ac.in/upload/hostel/hbr_affidavit.pdf

(Signature of the Applicant)

Date: September 24, 2019 Place:

Application for Jamia Boys Hostel New Admission (2019-20) 3/3 Application Ref. No. : JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/6040