JMI-WDAF-2012

JAMIA MILLIA ISLAMIA

Price : Rs. 200/-

Jamia Nagar, New Delhi-110025

Form No.

Application Form for Admission to

M.Phil./ M.Sc. Tech./ M.Tech.(Nanotechnology)/ M.A./ M.Sc./ M.Com/ M.I.B./ LL.M./MPT
B.A., LL.B./ BPT/ B.Lib./ P.G.Diploma/ Adv. Diploma/
Diploma and Certificate Courses 2012-2013
Roll No.
Affix your recent
self attested coloured

(To be filled in by the office)

Read the instructions given overleaf and in the prospectus carefully before filling up this form.

All the particulars must be filled in by the candidate in his/her own hand writing.

Applicant must ensure minimum eligibility conditions before applying.

Submission of Application Form will be no basis for claiming admission.

Do not attach copies of mark sheets, certificates etc. with this form, Original document with
attested copies along with Admit Card for Entrance Test shall be required at the time of interview.

Incomplete Application Form will NOT be considered.

photograph
(Size 2.0 x 1.5)
It should be pasted with
gum and covered with
transparent tape

1. Application Form for Admission to. ......................................................................................................................

2. Faculty.............................................................................................................Deptt.........................................
3. Category (See instruction no. 2 overleaf for category code).....................................................................................
4. Name :
(In block letters)
5. Fathers Name :
(In block letters)
6. Mothers Name :
(In block letters)
7. Fathers Occupation............................................................................................................
8. Address : (i) Present (for correspondence)
(ii) Permanent
..........................................................................................

........................................................................

.........................................................................................

........................................................................

State.................................................................................

State................................................................

PIN..............................Telephone No.................................

PIN........................Telephone No......................

9. Date of birth : (Based on Matriculation/Sec.School Certificate)

Date :

Month :

Year :

Nearest Railway Station.....................................

Age :

(As on 1/10/2012)

10. Nationality :..............................................

11. Sex:

12. Educational Qualifications :

S.No

Exams. Passed

1.

Matric/ S.S.C

2.

Intermediate/Sr.School
Certificate

3.

B.A./B.Sc./B.Com

4.

M.A./M.Sc./M.Com/LL.M.

5.

Others

Board/
University

Year Division

Agg.%

Subject
Studied

% of required
Subject (s)

13. Post Graduate Courses : Choice of specialization, if any : .................................................................................

14. DD No...................................................... Date ...........................................
(Note: In case of downloaded Application Form, the Demand Draft for Rs. 200/- should be made in favour of Jamia
Millia Islamia, payable at New Delhi)
Date...................

Signature of Applicant.....................................

DECLARATION
I SOLEMNLY UNDERTAKE to accept and abide by the rules of the Jamia Millia Islamia and all the decisions of the
Admission Committee and other appropriate University bodies in regard to my admission.
I SOLEMNLY AFFIRM that I have never been convicted by a court of law nor rusticated/expelled from any educational
institution nor disqualified/debarred from any examination.
I will accept the cancellation/forfeiture of my candidature in case any information supplied by me in this form is found to be
incorrect at the time of admission or thereafter.

Date...................................

Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I certify that the above particulars are correct. I agree that in the event of my son/daughter/
ward............................................................. being admitted to the Jamia Millia Islamia, New Delhi. I shall pay dues
and all personal expenses until the completion of the applicants studies. I also undertake full responsibility for the good
behaviour and conduct of the applicant.

Date..............................

..........................................................
Signature in full of the Parents/Guardian
Relation with student.....................................................
Address.......................................................................
...................................................................................
Telephone No................................................................
E-mail..........................................................................

INSTRUCTIONS
1. Code for Category:
G
MO
J

General
Muslim OBC
Jamia*

M
MT
K

Muslim General
Muslim ST
Kashmiri Migrant

MW
PD

Muslim Women
Persons with Disabilities

* Jamia as category of reservation shall only be applicable to courses for which qualifying examination is obtained
from Jamia Schools as provided in Jamia rules.
No change of category is permissible, once the choice has been made.
2. In case of downloaded Application Form a Bank Draft/Pay order (of a bank having its branch in New Delhi) should be
made in favour of Jamia Millia Islamia, payable at New Delhi. Candidate must write his/her name and number of his/
her Application Form on the back of the bank draft/pay order/cash receipt on top left conrner.
3. Filled Application Form complete in all respect along with the Bank Draft/Pay order, should be submitted in the office
of the Dean of the respective Faculty/Department/Centre by the last date indicated in the Prospectus.

FOR CENTRE

JAMIA MILLIA ISLAMIA

Form No.

Jamia Nagar, New Delhi-110025

Admit Card for Entrance Test 2012-2013

Roll No.
(To be filled by the office)

Course(s) applied for: ................................................. Dept./Faculty .............................

Name (In Block Letters):...........................................................................................................
Fathers Name:..................................................................................................................
Mothers Name:.................................................................................................................
Address:............................................................................................................................

Affix your recent

self attested coloured
photograph
(Size 2.0 x 1.5)

It should be pasted with gum

and covered with

.......................................
Signature of Applicant

.......................................
Signature of Invigilator

FOR CANDIDATE

transparent tape

Cut Here

JAMIA MILLIA ISLAMIA

Form No.

Jamia Nagar, New Delhi-110025

Admit Card for Entrance Test 2012-2013

Roll No.
(To be filled by the office)

Course applied for:................................................. Dept./Faculty .................................

Affix your recent
Name (In Block Letters) : ..........................................................................................................
self attested coloured
Fathers Name:..................................................................................................................
photograph
Mothers Name:.................................................................................................................
(Size 2.0 x 1.5)
Address:............................................................................................................................It should be pasted with gum
and covered with
transparent tape

.......................................
Signature of Applicant
Note:

.......................................
Signature of Invigilator

(i) Contact the Concerned Dept /Faculty for venue of Entrance Test.
(ii) Retain this Admit Card with you. It will have to be produced at the time of Entrance Test and
Interview.

Cut Here

Form No.

Acknowledgement Slip

Received an Application Form from (Candidate Name) ............................................................ for admission

to ................................................................................................course.

Date.................................

...........................................................
Signature of receiving official with Stamp