Application
Content
APPLICATION INSTRUCTIONS
Dear Applicant,
You are important to us.
We have exceptionally high standards for the talent that we take in our programmes. Superior leadership qualities, communication and
interpersonal skills, commitment, problem-solving ability, value driven mindset, professionalism, flexibility, motivation and sharp
intellectual curiosity are expected.
Please read the instructions in the Application Form-2016, carefully before you begin to fill your Application. The Application
form has to be filled in your own clear and legible handwriting and the undertaking is to be signed by you only.
This Application form is valid for the Amity University - Uttar Pradesh, Campuses in Noida, Lucknow, Greater Noida, Dubai and
London, Amity University- Rajasthan, Campus in Jaipur, Amity University - Haryana, Campus in Gurgaon (Manesar), Amity
University - Madhya Pradesh, Campus in Gwalior, Amity University - Chhattisgarh, Campus in Raipur, Amity University --Mumbai and Amity University --- Kolkata
•
•
For all details relating to Eligibility & Fee structure kindly refer to the list of programmes at www.amity.edu
Duly filled in Application Form together with a DD of Rs. 1,100/- (if not paid online) in favour of ‘‘Amity Form’’ payable at New
Delhi should be submitted/sent to the respective campus you are applying to :
Noida, Dubai & London Campus
Gurgaon (Manesar Campus)
Amity Admission Office, Sector-125,
Noida-201 313 (Adj. New Delhi)
Admission Helpline.: 0120-2445252 / 4713600
Amity Admission Office, Amity International School Campus,
Sector-46, Gurgaon-122413, (Haryana)
Admission Helpline.: 0124-2337015 / 16
Lucknow Campus
Gwalior Campus
Amity Admission Office, Malhaur( Near Railway Station),
Gomti Nagar Extension, Lucknow-226 010 (UP)
Admission Helpline:0522-2399418,6525676, 6050071-74
Amity University, Madhya Pradesh,
Maharajpura (Opposite Airport), Gwalior-474 005 (MP)
Admission Helpline.: 0751-3290666 / 3290667
Jaipur Campus
Mumbai Campus
Amity Admission Office, Amity House, 14 Gopal Bari, Ajmer
Road, Jaipur-302006, (Rajasthan)
Admission Helpline.: 0141-2372489 / 2374595
Amity Admission Office, Mumbai --- Pune Expressway, Bhatan,
Panvel, Maharasthra, 410206.
Admission Helpline.: 02143- 205037/8
Greater Noida Campus
Raipur Campus
Amity Admission Office, Plot no.48 A,
Knowledge Park III, Greater Noida (U.P.) - 201308.
Admission Helpline.: 0120-3000000
Amity Admission Office, Raipur --- Manth / Kharora
(Opp. ITBP ) SH --- 9, Chhattisgarh - 493225.
Admission Helpline.: 1800-123-5577
Kolkata Campus
Amity University Kolkata, Action Area II,
New Town, Kolkata.
•
Visit www.amity.edu (Admission Microsite Login) for all information relating to your application & admission after
submission of application form.
•
Qualifying candidates can select their date for Admission Process at www.amity.edu (Admission Microsite Login). It is your
responsibility to check the website for selection of date and appear in the Admission Process accordingly. No separate
communication will be sent in this regard.
•
You are advised to keep a photocopy of the complete application form.
•
Incorrectly filled, incomplete, unsigned forms & forms received after due date will be rejected.
•
Forms once rejected will not be reconsidered & form cost will not be refunded.
•
You cannot apply more than once for the same programme in one admission year.
•
Enclose class 10th mark sheet only with the Application Form. No other Mark sheets / Testimonials are to be attached with
the Application Form at this stage (Only foreign students / Foreign University Degree holder should attach photocopies of
academic transcripts & AIU Equivalence Certificate). University / Board / Marks filled in the Application Form will be
considered for all procedures related to admission. Any discrepancy found during original document verification will result in
cancellation of Admission.
•
Amity does not take any responsibility for delay or loss of the material in post/transit.
We do not accept any donations for admission. Merit is the only criteria.
Any instances found, even at a later date, will lead to cancellation of admission.
54487
Application Form Number
INSTRUCTIONS
1. Please read the instructions in the Admission Prospectus-2016 before filling up this form.
2. Use BLACK BALL POINT PEN to write in the boxes using English capital letters or English numerals.
3. Do not make any stray marks on this sheet
4. Do not pin, fold, scribble or tear this sheet.
5. Write in CAPTIAL LETTERS only within the box, in your own handwriting without touching the lines as shown in the
sample below.
5636850
User Name : 5636850
Password : 45b26f
0 1 2 3 4 5 6 7 8 9 A B C D E F G H I
J K L M N O P Q R S T U V W X Y Z
1. NAME OF THE CANDIDATE (as in candidate's class X marksheet or equivalent certificate - enclose photocopy)
R
A
H
U
L
J
A
I
N
2. MOTHER'S NAME (as in candidate's class X marksheet or equivalent certificate)
3. FATHER'S NAME (as in candidate's class X marksheet or equivalent certificate)
5. GENDER
4. PHYSICAL STANDARD
Height
6. CATEGORY
7. NATIONALITY
Indian
(Please tick)
(Please tick)
Weight
Male
kg.
cm
Female
GEN
ST
SC
OBC
(Please tick)
Others
If Other
Specify
8. PROGRAM APPLYING FOR (You may be offered option-2 in case you do not qualify for option-1.
9. DATE OF BIRTH
Choose option-2 from list of programs under same eligibility. Refer Admission Prospectus - 2016 for program code)
Program Code
Program Code
(as in candidate's class X marksheet or equivalent certificate)
Option-1
1
0
5
4
1D
Option-2
2
10. ADMISSION CATEGORY (Refer admission prospectus - 2016 for Fee and Category specification)
(Please tick)
Non-Sponsored
Sponsored
Company Sponsored
12. PREQUALIFYING TEST (If applicable) (Please tick) MAT
CAT
Date of Test
Form No.
NRI
D
D
Yes
M
2
M
-
1Y
Y
Y
Y
JEE
13. PASSPORT
(Applicable for
No.
Validity
D
D
M
M
Non AC
Amity Test
NATA
Y
.
Y
Y
L
.
Dubai Campus)
Require Student VISA?
Yes
No
14. Contact Numbers
Country Code
+
+
Mobile Number
9
1
9
9
Landline phone number with STD(area) code
1
0
6
5
3
4
6
0
R
E
15. MANDATORY E-MAIL ADDRESS (Only in Capital Letters)
R
A
H
U
L
J
A
I
N
7
2
@
D
I
F
F
M
A
I
16. Write your complete Correspondence address including
your name in English in Capital Letters with Black Pen.
(For any communication related to your admission)
Address :
O
M
(Within the Box Only)
17. SIGNATURE OF THE CANDIDATE
(Within the Box only)
City :
C
18. PHOTOGRAPH
- Write application Form no. at the back of a
recent color Photograph (size:3.5x4.5cm)
- Paste photograph (do not staple).
- Do Not Attest
Name :
State :
Country :
Postal Code (PIN/ZIP) :
1
2Y
Score
Y
Y
7Y
(Please tick)
Percentile
Roll Number (or) ID
9Y
If "Yes" AC
No
XAT
NMAT
M
0M
-
11. HOSTEL ACCOMMODATION
Foreign
GMAT
D6
5
Application Form No.
54487
6
3
6
8
5
0
19. EDUCATIONAL QUALIFICATIONS
It is mandatory to fill all details of educational qualification (as applicable) from class X onwards till last completed semester/year. if the system of marking of your school/college is on grading
pattern, convert grade into marks as applicable and fill in the respective columns. In absence of complete information, form will be rejected.
CLASS XII
CLASS X
CBSE
ICSE
NIOS
Passing Year
OTHERS
CBSE
ISC
NIOS
Passing Year
OTHERS
Board
Board
(Please tick)
(Please tick)
Aggregate percentage of all subjects on
class X marksheet (enclose photocopy)
.
Medium of instruction (Please tick)
English
Hindi
Others
Board Roll No.
Board Roll No.
CLASS XII BOARD RESULT DETAILS (Provide details of minimum 5 academic subjects as in class XII marksheet)
SUBJECT NAME
MARKS OBTAINED
MAXIMUM MARKS
GRADE / POINTS in %
(FOR INT. BOARDS)
XII School Name
City
Pin / Zip Code
XII Board Name (Recognised Board) For list of recognized Indian Boards refer www.cobse.org
GRADUATION DETAILS
Medium of instruction (Please tick) English
Branch/Subject of specialization (if any)
Name of Degree
Semester/Year wise Marks
Duration of Degree
Years
SEMESTER/
YEAR
Months
1
Scheme of Examination (Please tick)
Semester
Annual
Discipline (Please tick)
Arts
2
3
4
Commerce
Engineering
Management
5
6
Science
Others
Mode of study
(Please tick)
Full Time
7
8
9
Part Time
Correspondence
10
Hindi
Others
(please fill either MARKS or GPA information based on the evaluation system)
MARKS
OBTAINED
MAXIMUM
MARKS
/
/
/
/
/
/
/
/
/
/
2
SGPA*/CGPA*
OBTAINED
NO OF BACK PAPER(S)
(If not cleared till date)
.
.
.
.
.
.
.
.
.
.
*Scale used in case of SGPA/CGPA
Application Form No.
54487
Graduation - Years
Attended From
5
6
3
6
8
5
0
University
Enrollment
No.
To :
Name of the University
Name of the College
City
Pin / Zip Code
POST GRADUATION DETAILS
Medium of instruction
(Please tick)
English
Branch/Subject of specialization (if any)
Name of Degree
Years
Attended From
Y
Y
Y
Y
To :
Y
Y
Y
Y
Hindi
Others
University
Enrollment No.
Name of the University
City
Semester/Year wise Marks
Months
3
Annual
4
Discipline (Please tick)
5
Arts
Commerce
Engineering
Management
Science
Others
Mode of Study
6
(Please tick) Full Time
SGPA*/CGPA*
OBTAINED
/
/
/
/
/
/
2
Scheme of Examination (Please tick)
Semester
MAXIMUM
MARKS
1
Duration of Degree
Years
(please fill either MARKS or GPA information based on the evaluation system)
MARKS
OBTAINED
SEMESTER/
YEAR
Part Time
NO OF BACK PAPER(S)
(If not cleared till date)
.
.
.
.
.
.
*Scale used in case of SGPA/CGPA
Correspondence
20. AWARDS / ACHIEVEMENTS (if any, latest two) Proof will be verified on the day of selection
For what
Received when
Name
21. EMPLOYMENT HISTORY (if applicable) Work Experience?
(Please tick) Yes
Last Organisation Name
if "Yes", total years Years
of work experience
No
Months
Last Designation
Date From
D
D
Date To
M
M
Y
Y
22. FAMILY INFORMATION
Country Code
Y
Y
D
D
Last salary drawn per month in INR
M
M
Y
Y
Y
Y
Part-Time
Parent Email ID (only in capital letters)
Father's Mobile No.
Country Code
3
Full-Time
Mother's Mobile No.
5
Application Form No.
54487
Age
3
6
8
Organisation
Profession
Qualification
6
5
0
Designation
Father
Mother
23. PREVIOUSLY APPLIED
Have you previously applied to Amity ? (Please tick)
Yes
No
If Yes
Year
Previous Form No. :
24. FAMILY AT AMITY (if applicable)
Yes
Were you Selected ? (Please tick)
Employee
Association of any family member with Amity (Please tick)
Student
No
Alumni
Name of the Family Member
Institute Name
Program Name (if Student / Alumni) / Designation (If Employee)
Year From
Duration
Y
Y
Year To
Y
Y
Y
Y
Your relationship with associated Amitian? (Please tick)
Y
Y
Grandparent
Parent
Spouse
Sibling
25. CORRESPONDENCE ADDRESS (same as point 16)
Address
City :
PIN / ZIP
Code :
State :
Country
26. WRITE YOUR COMPLETE PERMANENT ADDRESS (if different from correspondence address)
Address :
City :
PIN / ZIP
Code :
State :
Country
27. Do you suffer from any chronic ailment or disability :
Yes
No
If "Yes" give details:
28. Have you ever been suspended, dismissed or put on academic probation or warning at any school or college?
If "Yes" please explain on a separate sheet of paper.
Yes
No
29. Details of Payment of Form
BY DEMAND DRAFT
DD No.
Date : D
MICR No.
D
-
M M
-
Y
Y
(9digit number next to DD No. on the Demand Draft)
THROUGH ONLINE
Receipt No.
Online Transaction No.
Date :
30. SIGNATURE
I hearby certify that the information given in the Application (all relevant Forms) is complete and accurate.
I understand and agree that misrepresentation or omission of facts will justify the denial of admission, the cancellation of admission, or expulsion.
I have read, understood and do hereby consent to the Terms & Conditions for Admission as mentioned in Admission Prospectus 2016.
I have enclosed photo copy of class X marksheet or equivalent certificate.
Date :
Signature :
4
For
office use
only
Dear Applicant,
You are important to us.
We have exceptionally high standards for the talent that we take in our programmes. Superior leadership qualities, communication and
interpersonal skills, commitment, problem-solving ability, value driven mindset, professionalism, flexibility, motivation and sharp
intellectual curiosity are expected.
Please read the instructions in the Application Form-2016, carefully before you begin to fill your Application. The Application
form has to be filled in your own clear and legible handwriting and the undertaking is to be signed by you only.
This Application form is valid for the Amity University - Uttar Pradesh, Campuses in Noida, Lucknow, Greater Noida, Dubai and
London, Amity University- Rajasthan, Campus in Jaipur, Amity University - Haryana, Campus in Gurgaon (Manesar), Amity
University - Madhya Pradesh, Campus in Gwalior, Amity University - Chhattisgarh, Campus in Raipur, Amity University --Mumbai and Amity University --- Kolkata
•
•
For all details relating to Eligibility & Fee structure kindly refer to the list of programmes at www.amity.edu
Duly filled in Application Form together with a DD of Rs. 1,100/- (if not paid online) in favour of ‘‘Amity Form’’ payable at New
Delhi should be submitted/sent to the respective campus you are applying to :
Noida, Dubai & London Campus
Gurgaon (Manesar Campus)
Amity Admission Office, Sector-125,
Noida-201 313 (Adj. New Delhi)
Admission Helpline.: 0120-2445252 / 4713600
Amity Admission Office, Amity International School Campus,
Sector-46, Gurgaon-122413, (Haryana)
Admission Helpline.: 0124-2337015 / 16
Lucknow Campus
Gwalior Campus
Amity Admission Office, Malhaur( Near Railway Station),
Gomti Nagar Extension, Lucknow-226 010 (UP)
Admission Helpline:0522-2399418,6525676, 6050071-74
Amity University, Madhya Pradesh,
Maharajpura (Opposite Airport), Gwalior-474 005 (MP)
Admission Helpline.: 0751-3290666 / 3290667
Jaipur Campus
Mumbai Campus
Amity Admission Office, Amity House, 14 Gopal Bari, Ajmer
Road, Jaipur-302006, (Rajasthan)
Admission Helpline.: 0141-2372489 / 2374595
Amity Admission Office, Mumbai --- Pune Expressway, Bhatan,
Panvel, Maharasthra, 410206.
Admission Helpline.: 02143- 205037/8
Greater Noida Campus
Raipur Campus
Amity Admission Office, Plot no.48 A,
Knowledge Park III, Greater Noida (U.P.) - 201308.
Admission Helpline.: 0120-3000000
Amity Admission Office, Raipur --- Manth / Kharora
(Opp. ITBP ) SH --- 9, Chhattisgarh - 493225.
Admission Helpline.: 1800-123-5577
Kolkata Campus
Amity University Kolkata, Action Area II,
New Town, Kolkata.
•
Visit www.amity.edu (Admission Microsite Login) for all information relating to your application & admission after
submission of application form.
•
Qualifying candidates can select their date for Admission Process at www.amity.edu (Admission Microsite Login). It is your
responsibility to check the website for selection of date and appear in the Admission Process accordingly. No separate
communication will be sent in this regard.
•
You are advised to keep a photocopy of the complete application form.
•
Incorrectly filled, incomplete, unsigned forms & forms received after due date will be rejected.
•
Forms once rejected will not be reconsidered & form cost will not be refunded.
•
You cannot apply more than once for the same programme in one admission year.
•
Enclose class 10th mark sheet only with the Application Form. No other Mark sheets / Testimonials are to be attached with
the Application Form at this stage (Only foreign students / Foreign University Degree holder should attach photocopies of
academic transcripts & AIU Equivalence Certificate). University / Board / Marks filled in the Application Form will be
considered for all procedures related to admission. Any discrepancy found during original document verification will result in
cancellation of Admission.
•
Amity does not take any responsibility for delay or loss of the material in post/transit.
We do not accept any donations for admission. Merit is the only criteria.
Any instances found, even at a later date, will lead to cancellation of admission.
54487
Application Form Number
INSTRUCTIONS
1. Please read the instructions in the Admission Prospectus-2016 before filling up this form.
2. Use BLACK BALL POINT PEN to write in the boxes using English capital letters or English numerals.
3. Do not make any stray marks on this sheet
4. Do not pin, fold, scribble or tear this sheet.
5. Write in CAPTIAL LETTERS only within the box, in your own handwriting without touching the lines as shown in the
sample below.
5636850
User Name : 5636850
Password : 45b26f
0 1 2 3 4 5 6 7 8 9 A B C D E F G H I
J K L M N O P Q R S T U V W X Y Z
1. NAME OF THE CANDIDATE (as in candidate's class X marksheet or equivalent certificate - enclose photocopy)
R
A
H
U
L
J
A
I
N
2. MOTHER'S NAME (as in candidate's class X marksheet or equivalent certificate)
3. FATHER'S NAME (as in candidate's class X marksheet or equivalent certificate)
5. GENDER
4. PHYSICAL STANDARD
Height
6. CATEGORY
7. NATIONALITY
Indian
(Please tick)
(Please tick)
Weight
Male
kg.
cm
Female
GEN
ST
SC
OBC
(Please tick)
Others
If Other
Specify
8. PROGRAM APPLYING FOR (You may be offered option-2 in case you do not qualify for option-1.
9. DATE OF BIRTH
Choose option-2 from list of programs under same eligibility. Refer Admission Prospectus - 2016 for program code)
Program Code
Program Code
(as in candidate's class X marksheet or equivalent certificate)
Option-1
1
0
5
4
1D
Option-2
2
10. ADMISSION CATEGORY (Refer admission prospectus - 2016 for Fee and Category specification)
(Please tick)
Non-Sponsored
Sponsored
Company Sponsored
12. PREQUALIFYING TEST (If applicable) (Please tick) MAT
CAT
Date of Test
Form No.
NRI
D
D
Yes
M
2
M
-
1Y
Y
Y
Y
JEE
13. PASSPORT
(Applicable for
No.
Validity
D
D
M
M
Non AC
Amity Test
NATA
Y
.
Y
Y
L
.
Dubai Campus)
Require Student VISA?
Yes
No
14. Contact Numbers
Country Code
+
+
Mobile Number
9
1
9
9
Landline phone number with STD(area) code
1
0
6
5
3
4
6
0
R
E
15. MANDATORY E-MAIL ADDRESS (Only in Capital Letters)
R
A
H
U
L
J
A
I
N
7
2
@
D
I
F
F
M
A
I
16. Write your complete Correspondence address including
your name in English in Capital Letters with Black Pen.
(For any communication related to your admission)
Address :
O
M
(Within the Box Only)
17. SIGNATURE OF THE CANDIDATE
(Within the Box only)
City :
C
18. PHOTOGRAPH
- Write application Form no. at the back of a
recent color Photograph (size:3.5x4.5cm)
- Paste photograph (do not staple).
- Do Not Attest
Name :
State :
Country :
Postal Code (PIN/ZIP) :
1
2Y
Score
Y
Y
7Y
(Please tick)
Percentile
Roll Number (or) ID
9Y
If "Yes" AC
No
XAT
NMAT
M
0M
-
11. HOSTEL ACCOMMODATION
Foreign
GMAT
D6
5
Application Form No.
54487
6
3
6
8
5
0
19. EDUCATIONAL QUALIFICATIONS
It is mandatory to fill all details of educational qualification (as applicable) from class X onwards till last completed semester/year. if the system of marking of your school/college is on grading
pattern, convert grade into marks as applicable and fill in the respective columns. In absence of complete information, form will be rejected.
CLASS XII
CLASS X
CBSE
ICSE
NIOS
Passing Year
OTHERS
CBSE
ISC
NIOS
Passing Year
OTHERS
Board
Board
(Please tick)
(Please tick)
Aggregate percentage of all subjects on
class X marksheet (enclose photocopy)
.
Medium of instruction (Please tick)
English
Hindi
Others
Board Roll No.
Board Roll No.
CLASS XII BOARD RESULT DETAILS (Provide details of minimum 5 academic subjects as in class XII marksheet)
SUBJECT NAME
MARKS OBTAINED
MAXIMUM MARKS
GRADE / POINTS in %
(FOR INT. BOARDS)
XII School Name
City
Pin / Zip Code
XII Board Name (Recognised Board) For list of recognized Indian Boards refer www.cobse.org
GRADUATION DETAILS
Medium of instruction (Please tick) English
Branch/Subject of specialization (if any)
Name of Degree
Semester/Year wise Marks
Duration of Degree
Years
SEMESTER/
YEAR
Months
1
Scheme of Examination (Please tick)
Semester
Annual
Discipline (Please tick)
Arts
2
3
4
Commerce
Engineering
Management
5
6
Science
Others
Mode of study
(Please tick)
Full Time
7
8
9
Part Time
Correspondence
10
Hindi
Others
(please fill either MARKS or GPA information based on the evaluation system)
MARKS
OBTAINED
MAXIMUM
MARKS
/
/
/
/
/
/
/
/
/
/
2
SGPA*/CGPA*
OBTAINED
NO OF BACK PAPER(S)
(If not cleared till date)
.
.
.
.
.
.
.
.
.
.
*Scale used in case of SGPA/CGPA
Application Form No.
54487
Graduation - Years
Attended From
5
6
3
6
8
5
0
University
Enrollment
No.
To :
Name of the University
Name of the College
City
Pin / Zip Code
POST GRADUATION DETAILS
Medium of instruction
(Please tick)
English
Branch/Subject of specialization (if any)
Name of Degree
Years
Attended From
Y
Y
Y
Y
To :
Y
Y
Y
Y
Hindi
Others
University
Enrollment No.
Name of the University
City
Semester/Year wise Marks
Months
3
Annual
4
Discipline (Please tick)
5
Arts
Commerce
Engineering
Management
Science
Others
Mode of Study
6
(Please tick) Full Time
SGPA*/CGPA*
OBTAINED
/
/
/
/
/
/
2
Scheme of Examination (Please tick)
Semester
MAXIMUM
MARKS
1
Duration of Degree
Years
(please fill either MARKS or GPA information based on the evaluation system)
MARKS
OBTAINED
SEMESTER/
YEAR
Part Time
NO OF BACK PAPER(S)
(If not cleared till date)
.
.
.
.
.
.
*Scale used in case of SGPA/CGPA
Correspondence
20. AWARDS / ACHIEVEMENTS (if any, latest two) Proof will be verified on the day of selection
For what
Received when
Name
21. EMPLOYMENT HISTORY (if applicable) Work Experience?
(Please tick) Yes
Last Organisation Name
if "Yes", total years Years
of work experience
No
Months
Last Designation
Date From
D
D
Date To
M
M
Y
Y
22. FAMILY INFORMATION
Country Code
Y
Y
D
D
Last salary drawn per month in INR
M
M
Y
Y
Y
Y
Part-Time
Parent Email ID (only in capital letters)
Father's Mobile No.
Country Code
3
Full-Time
Mother's Mobile No.
5
Application Form No.
54487
Age
3
6
8
Organisation
Profession
Qualification
6
5
0
Designation
Father
Mother
23. PREVIOUSLY APPLIED
Have you previously applied to Amity ? (Please tick)
Yes
No
If Yes
Year
Previous Form No. :
24. FAMILY AT AMITY (if applicable)
Yes
Were you Selected ? (Please tick)
Employee
Association of any family member with Amity (Please tick)
Student
No
Alumni
Name of the Family Member
Institute Name
Program Name (if Student / Alumni) / Designation (If Employee)
Year From
Duration
Y
Y
Year To
Y
Y
Y
Y
Your relationship with associated Amitian? (Please tick)
Y
Y
Grandparent
Parent
Spouse
Sibling
25. CORRESPONDENCE ADDRESS (same as point 16)
Address
City :
PIN / ZIP
Code :
State :
Country
26. WRITE YOUR COMPLETE PERMANENT ADDRESS (if different from correspondence address)
Address :
City :
PIN / ZIP
Code :
State :
Country
27. Do you suffer from any chronic ailment or disability :
Yes
No
If "Yes" give details:
28. Have you ever been suspended, dismissed or put on academic probation or warning at any school or college?
If "Yes" please explain on a separate sheet of paper.
Yes
No
29. Details of Payment of Form
BY DEMAND DRAFT
DD No.
Date : D
MICR No.
D
-
M M
-
Y
Y
(9digit number next to DD No. on the Demand Draft)
THROUGH ONLINE
Receipt No.
Online Transaction No.
Date :
30. SIGNATURE
I hearby certify that the information given in the Application (all relevant Forms) is complete and accurate.
I understand and agree that misrepresentation or omission of facts will justify the denial of admission, the cancellation of admission, or expulsion.
I have read, understood and do hereby consent to the Terms & Conditions for Admission as mentioned in Admission Prospectus 2016.
I have enclosed photo copy of class X marksheet or equivalent certificate.
Date :
Signature :
4
For
office use
only
