8/2/2019 Pg Hamdard

1/2

JAMIA HAMDARD(HAMDARDUNIVERSITY)

HAMDARDNAGAR,NEW DELHI-110062

ApplicationFormFor Ph.D./P.G./U.G./Diploma&CertificateCourses Admission-2012

INCOMPLETE APPLICATIONIN ANY RESPECT SHALL NOT BECONSIDERED

(1) NOTE: Please attach a Demand Draft for Application Fees of Rs. 500/- plus Rs. 250/- for each preference of

course. For example - If you choose two preferences than you have to pay Rs. 500 + 250 + 250 = 1000/-. (2) Please fill in all the entries in CAPITALLETTERS using a .

(3) (4) DO N OT STAPL E/ PI N ANY D OC UMEN T WIT H T HI S F OR M (Use C lip). (5) Sa me f orm can b e u se d f or a pp lyin g f or a dmission t o more t ha n o ne

programme.However,thecandidatehas toenclosetestprocessingfeeaccordingto thenumber ofprogrammeshe/sheis applyingfor.Separateformshouldbefilledforseparatediscipline.

Readthe InformationBulletin & Prospectus-2012-13carefullybeforefillingin form.

BLACK BALL POINT PEN only

Fill bubbles with black ball point pen only.

IMPORTANTINSTRUCTIONS

IndianNational Form.No.

1. Preference(s)forAdmission(Writeprogrammecodes in theboxes in orderof preferencefor admission. SeeinformationBulletin& Prospectus- 2012 - 13 forprogrammecodes)

Signatureof Applicant

(Nottobesigned)

Paste3.53.5cmSizeColor

Photographwithinthisbox

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ProgrammeCode

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Applicationfor : Ph.D/M.PhilCourses PostGraduationCourses Under Graduate/Diploma/Certificate/Pre-TibCourses

Centre1

8.CentreChoice(Allthechoiceshavetobefilled)

Centre2 Centre3

9.InternalCandidate

Information

10.Gender

Male

Female

11.StateofDomicile

QualifyingExamCode

(SeeinformationBulletin&Prospectus2012-13forCodesforfillingintheboxesshownbelow) 12.QualifyingExam.Details(SeeInformationBulletin&Prospectus2012-13forCodes)

Board/UniversityYearofPassing/

Appearing PercentageMAT/CMAT/CAT/GPAT

(Score)

NETQualified(forPh.D)

Yes

No

MoUCatforPh.D

NET(JRF)

NET (LS)from

UGC/CSIR

Otherequivalent

exam

fromGovt.Agencies

IfNETQualified

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Yes

No

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2.Nameasinclass10thcertificate(UseCAPITAL LETTERSonly.LeaveablankboxbetweenFirst,Middle&LastNames).Fillthecircleaccordingly.

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GD/InterviewwillbeconductedinJamiaHamdard,NewDelhi.

3.JamiaHamdardEmployeesWard

Yes

No

4.SocialCategory

GEN

SC

ST

5.Category

Physicallychallenged

Sportsperson

6.Religion

Budhism

Christianity

Hinduism

Islam

Jainism

Parsi

Sikhism

Others

7.Dateofbirth

Day Month Year

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Yes No

8/2/2019 Pg Hamdard

2/2

14.ParentsMonthlyIncome:Rs.

Date: M MD D Y YSignatureof Applicant

13.Nationality:

Name:

S/oorD/o:

City/District:

PhoneNo.(LocalDelhi,ifany):

16.MothersName:

MAILING ADDRESS PERMANENT ADDRESS

Examination

HighSchool(Class10 )th

12 /Intermediateth

Graduation(writethenameof

thedegree)

1 Yrst

2 Yrnd

3 Yrrd

4 Yrth

5 Yrth

Post-Graduation(writethenameofthedegree)

1 Yrst

2 Yrnd

3 Yrrd

Almiyat

Fazeelat

AnyOther

DECLARATIONBYTHE APPLICANT

NameofSchool/College&Place

Board/University

Subject(In Abbreviations)Yearof

Passing%or

Grade

I ........................................................................................................S/O or D/O ..................................................................................................... declare thatall the statements given in this application form are true to the best of my knowledge. I understand that if any of the statements is found wrong my admission willstand cancelled. If admitted, I will abide by the rule & regulations in force in Jamia Hamdard and as amended from time to time and pay the prescribed feeregularly.

20.Have you ever beendebarredfromany exam/rusticated fromany School/College/University/Institution. Yes No

STDCode: PhoneNo.:

Reason NameoftheSchool/College/University/Institution Year

21.HaveyoueverbeenenrolledinJamiaHamdard?

Nameoftheregularcourseenrolled Year EnrollmentNumber

22.DETAIL OFPAYMENT

DraftNo. DateofIssue DraweeBankAmount

Address:

Name:

S/oorD/o:

State:

City/District:

Address:

Pin:

Email:

Pin:

15.FathersName:Indian Yes NoIfNo,SpecifyNationality:

Mothers SignatureFathers Signature

19.DetailsofExaminationPassed

17. 18.

23.

Form.No.________________

MobileNo.State: MobileNo.

NameoftheCandidate

Yes No

Ifyes,

Ifyes,