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Application for P.G. Diploma (Distance Mode) (2021-22)

REGISTRATION NO:
JMI925906PGDGC PAYMENT ID:
JMIDOE61a125f617a18998

AAdhar No: 219330104693

Course Name:
Post Graduate Diploma in Guidance & Counselling
‫ کورس کا نام‬/ पाठयक्रम का नाम :

Candidate Name:
KULDEEP
‫ درخواست گزار کا نام‬/आवेदक का नाम :
Father's Name:
Vivek
‫ والد کا نام‬/ पिता का नाम :
Mother's Name:
Kavita
माता का नाम:
Father's / Mother's / Spouse (if 9212132627
married) Mobile Number:

‫ والدہ کا موبائل نمبر@والد‬/पिता / माता

का मोबाइल नंबर :
Date of Birth:
01 March, 1997
‫ تاریخ پیدائش‬/ जन्म तिथि :

Sex/‫ جنس‬/लिंग: Male Social Category/‫کالس‬/वर्ग: GENERAL

Blood Group:
A+
‫ بلڈ گروپ‬/ ब्लड ग्रुप :
Nationality/‫قومیت‬//राष्ट्रीयता : Indian
Religion/‫مذہب‬/धर्म: HINDU

Address For Correspondence  पत्राचार का पता Permanent Address  स्थायी पता

Name:
KULDEEP Guardian's Name (If Vivek
‫ درخواست گزار کا نام‬/ आवेदक Applicable)

का नाम

Address / ‫ پتہ‬/पता : H.no 121 poly wala rana pana v.p.o qutabgarh delhi Address / ‫ پتہ‬/पता : H.no 121 poly wala rana pana v.p.o qutabgarh delhi

  Near bawana   Near bawana

   

District / ‫ ضلع‬/जिला: North west delhi District / ‫ ضلع‬/जिला: North west delhi

State / ‫ ریاست‬/ राज्य: Delhi State / ‫ ریاست‬/ राज्य: Delhi

Pin / ‫ ِپ ن‬/ पिन: 110039 Pin / ‫ ِپ ن‬/ पिन: 110039

Ph. No. with STD Code Ph. No. with STD Code

Mobile No./‫موبائل نمبر‬/ (+91) 9899329329 Fax No.

मोबाइल नंबर:
Mobile No./‫موبائل نمبر‬/ (+91) 9899329329
Email kuldeeprana1429@gmail.com मोबाइल नंबर:

Annual Income of your Parents/Guardians in Rs. Upto 1 lacs

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Name(HTTPS://JMI.UCANAPPLY.COM/UNIVER/PUBLIC/USER-LOGOUT?APP_ID=UELZMDAWMDA0NG==)
of the Examination Board / University Year of Passing / School Name/College Max Marks Marks Marks CGPA
Appearing Obtd. %

(10+2)th std. Central Board of Secondary Education, Delhi 2014 GBSSS bawana 500 327 65.4

guru gobind singh indraprastha university, amity school of eng. and

Bachelor Degree 2019 62.20
delhi technology

Support Centre Preference

Preference - 1 (JSC-DL-01) Center for Distance and open Learning Jamia Millia Islamia Jamia Nagar NEW Delhi

Uploaded Documents:
1. Original Marksheet of Graduation

Signature Uploaded by the

candidate/ ‫بذریعہ امیدوار‬
‫ َا پلوڈیڈ دستخط‬/ अभ्यर्थी द्वारा
अपलोडेड हस्ताक्षर

It is hereby confirmed that I have carefully read the concerned Information Bulletin available on the JMI's Entrance Test Portal (www.jmionline.in) before filling up the Application Form.

I hereby solemnly affirm that the information furnished in this Online Application Form is true and correct to the best of my lnowledge and belief and no material information has been
concealed or suppressed. If any information is found to be false, incorrect or misleading, the Jamia Millia Islamia shall have the authority to cancel my candidature / admission without any
further enquiry or notice.

I undertake that, if admitted, I shall abide by the UGC Regulations on Curbing the Menace of Ragging, 2009, Ordinances governing the discipline of students of Jamia Millia Islamia and such
other Rules, Ordinances and Regulations that may be framed by the Jamia Millia Islamia/ UGC from time to time.

I further undertake that the preference for the Test center, Courses, Domicile and the categories to which I belong as indicated by me in the online application form shall be irrevocable.

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