Helpline No : 011-26059688 Extn.

5389
(Monday to Friday 10:00 AM to 5:00 PM)
Email: admissions@jamiahamdard.ac.in
ADMISSION 2019-20

Application ID JH/UGL/10629

Admission Session 2019-20 Program name Lateral Entry UG Programmes

Category of Form GENERAL (INDIAN) Billed Amount 1526.55

Course Details
Preference 1 Preference 2 Preference 3 Preference 4
B.SC MEDICAL IMAGING
TECHNOLOGY (LATERAL ENTRY)
Preference 5 Preference 6 Preference 7 Preference 8

Applicant Name NISHAHAT ALI Father's Name LATAFAT HUSAIN

Social Category GENERAL Mother's Name MISKEEN JAHAN
Physically Challenged NO Parent Annual Income BELOW 5 LAKHS
Religion ISLAM Mobile Number +91-8077447188
Date of Birth (DD-MM-YY) 06/04/1998 Email ID NISHAHATALI4@GMAIL.COM
Gender MALE JH-Employee's Ward NO
State of Domicile UTTAR PRADESH Sports Person NO
Aadhar Number 687976827717 Internal Candidate Info JAMIA HAMDARD, NEW DELHI
MOHALLA
Correspondence address MANSOORPUR UJHARI Permanent address R-170/6 SECOND FLOOR
AMROHA
Correspondence Pincode 110025 Permanent Pincode 110025
U.P. BOARD OF HIGH SCHOOL AND
Name of the Exam 12th Qualifying Board
INTERMEDIATE EDUCATION
Percentage/CGPA 74 Year of Passing 2015

Diploma Details
Name of
Roll Result Obtained Maximum Year of
the Board/University Percentage/CGPA
Number Status Percentage/CGPA Percentage/CGPA Passing
Institute
JAMIA JAMIA HAMDARD,
1008 AWAITED
HAMDARD DELHI
Declaration: I certify that the information submitted by me in support of this application, is true to the best of knowledge and belief. I
understand that in the event of any information being found false or incorrect, my admission is liable to be rejected / cancelled at any stage of
the program. I undertake to abide by the disciplinary rules and regulations of the institute.

Candidate Signature