Application No: 40300742/SCXX

NRI
Selected/Chance Memo/
Special Category Rank
ALIGARH MUSLIM UNIVERSITY
ONLINE PAYMENT

Session: 2019 - 2020 Roll No. : 0

Application Form for admission to
XI Science
Senior Secondary Schools

Bank: 530, CR No./Online Txn No.: 821169637, Date: 2019-06-10 13:53:07, Amount: 5020.06 Nationality: INDIAN

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Choices :
PCBX PCMX
NRI/Foriegn Nationals are exempted from Entrance Test
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Personal Details:
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Name: SYED NAMEERUR REHMAN Father's Name: SYED RAZIUR RAHMAN

Date of Birth: 17-04-2003 Mother's Name: SARAH ALI
Gender: MALE
Religion: Islam

Details of Qualifying Examination: Status & Special Categories:

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Examination: SECONDARY SCHOOL EXAMINATION Status:
Enrolment No.:
Roll No.: 8104816
Hall:
Year of Passing/Appearing: 2019 Special Categories: 1. CA 2. NA 3. NA
Board/Univ.: Central Board of Secondary Education, Delhi
Marks Obt./Max. Marks: 386/500
Remarks (if any):

Name of the Examination Board/University Year Roll No. % of Marks

secondary school examination cbse 2019 8104816 77.2
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Permanent Address: Address for Correspondence:

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Address: 168 GREENPARK COLONY Address: 117 SECTOR D PRIYADARSHINI COLONY
BERASIA ROAD SITAPUR ROAD
BHOPAL - 462001(MP) LUCKNOW - 226020(UP)

Phone 1: 6391312694 Phone 2: 8827072326 Email ID:

Is hostel accommodation required? YES (Hostel accommodation is not guaranteed; it is subject to availability of seats in the hostel)
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DECLARATION: I SOLEMNLY UNDERTAKE to accept and abide by the rules of the Aligarh Muslim University and all the decisions of the Academic
Council & other appropriate University bodies in regard to my admission. I hereby solemnly affirm that I have gone through the Guide to Admissions &
Supplements applicable for this course and solemnly declare on oath that the entries made by me in the above columns are true to the best of my
INE PAYMENT

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.
Application No: 40300742/SCXX

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Signature of the Candidate
Left Hand Thumb Impression (for All candidates)