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Form School Middle 2013 2014

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Rs. 250/Form No. ....................... .......................  JMI–WDAF–2013

 JAMIA MIDDLE SCHOOL

    

Affix your recent photo (size 2"x1.5") self attested. P hotograph should be pasted with gum and not stapled or pinned.



 JAMIA MILLIA ISLAMIA  JAMIA NAGAR, NEW DELHI - 110025

2013 – 2014 Application Form Reg.No.

Read the Prospectus carefully and Instructions printed overleaf before filling up this Application Form. Incomplete Form will not be considered. 1.

Application for Class:

Category

Male

Female

(See Code at the back)

    

2. 3. 4.

Name of of Ca Candidate (in block letters):

       Father's Name       Mother's Name  

5.

    Name of guardian (if any)      

6.

Nationality : ...........................................

7.

Annua Annuall Inco Income me of of fat father her or guar guardia dian n (if fath father er is not alive) alive)

8.

State to which Candidate belongs

9.

 :           

    :.......................................................................................... Loca Locall Mai Maili ling ng Addr Addres esss (if (if any) any)  10 Permanent Address :     : ..................................................................................................... ..................................................................................................... ..................................................................................................... Pin ....................... ....................... Phone No............................................ No................................................... .......

11.

 :  Nearest Railway Station (for Railway concession) concession)                   Dat Date of of Bir Birtth (in (in wo word rdss)       : ....................................................................................................................... (in figures) :

Day



Month





Place of Birth   :

13.

Last Examination Passed

14.

Inst Instit itut utio ion n last last atte attend nded ed   

Year

Institution

 : 

Year

 District  :  State 

12.

15.

............................................................................ ............................................................................ ..................... ..................... State  .............................. Pin ................... Phone No ..............................

Result

Grade/Percentage

 :...................................................................................................................................... 

Bank Draft No. ........................... ........................... Date ................. Drawn on Bank ........................................ ............................................... ....... Rs. ........................... ........................... (only for downloaded forms) ....................................................... Signature of Applicant   

Date    .........................

--------- -------- -------- ------- --------- -------- -------- ------- --------- -------- ------ --Acknowledgement Acknowledgement Slip

Form No. ....................... .......................

Received Application Form from  for class  on  Reg. No. 

 Dealing Asstt. P.T.O.

INSTRUCTIONS Note:

1. Category code should be given carefully. Incorrect proclamation of the category shall lead to immediate cancellation of form/admission.

CODE GE M MW MO MT PD KM

              CATEGORY   

 



      

General Muslim Muslim Women Muslim OBC Muslim Sheduled Tribe Persons with Disability Kashmiri Migrant

2. Do not attach original copies of certificate of marks-sheet etc. with the form. 3. If the application is sent by post, the candidate should collect the Acknowledge Slip before the Draw of Lots. 4. Recent self attested photograph should be pasted with gum and not stapled or pinned. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------

DECLARATION I, hereby, solemnly declare that: i) ii)

The information given in the form is true to the best of my knowledge and belief, and I have read the rules printed in the School Prospectus and agree to abide by them and accept the changes (if any) made therein at a later stage.

     

   

 





Date 

Signature of Father/Mother/Guardian

Signature of Applicant

CERTIFICATE (For Jamia Employee's son/ daughter only) Certified that Mr. / Mrs. .............................................................................................................................................................................. (Name of employee) father/mother of ................................................................................................................ is an employee of Jamia Millia Islamia and (Name of candidate)

has been working in ....................................................................................................... as .................................................................... on (Name of candidate) permanent / probation / temporary /adhoc / contract / daily wages basis since .................................................

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

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

Counter Signature

Head of the Deptt. / Office / School

S.O.

Office Stamp

(Medical Section, J.M.I

Schedule of Lottery Draw 2013-2014 Jamia Middle School Class

Date

Time

II

15 April, 2013

th

02:30 p.m.

V

16 April, 2013

th

02:30 p.m.

VI

17 April, 2013

th

02:30 p.m.

Place Multi Purpose Hall, Sr. Secondary School, JMI

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