Application Form No_______

PRICE: Rupees One Hundred Only

(For office use only)
(1) Enrolment No.
SESSION: 200 - 200

Paste Attested
Photo

Centre for Distance Education

ALIGARH MUSLIM UNIVERSITY, ALIGARH

Application Form for Admission

(2) Name of the Course Applied For
(3) Study Centre opted by the Candidate

(4) Total Amount Paid Rs__________________

DD/Cash
No.

(5a)

Receipt

Dated

Amount
(Rs.)

Please tick marks for medium of course for class XI and B.A.
Main Subject: (Please tick mark for B.A. Course)
Compulsory Subjects

HINDI / URDU

HISTORY / POLITICAL SCIENCE / URDU

(Please tick mark for class XI, B.A. and B.Com): Compulsory English /Theology

(Sunni/Shia/INM( for B.A. or B.Com)/HMC(for XI)), Urdu (Adv/Ele.)/ Hindi Ele.

Please Mention Subsidiary Subjects for class B.A.
(i) ____________________________________ (ii) ______________________________________
(5b) Please Mention Optional Subjects for class XI
(i) ______________________ (ii) _________________________ (iii) __________________________

(6) Name of the Candidate

(as in HS/SS Certificate in Capital letter)
(7) Date of Birth
in Figures _________________________
(as in HS/SS Certificate)
In Words _________________________
(11) Fathers Name ______________________________
(12) Mothers Name_____________________________
(13) Details of Qualifying Examination
Examination
Roll No.
Year of
Board/
passing/
University
appearing

Marks
Obtained

(8) Sex (M/F

(9) Nationality___________
(10) State/UT of India (Code)

Maximum
Marks

Division

Remarks

*Write Result Awaited (RA) if result is not declared

(13) a. Details of Subjects Offered in qualifying Examination
Subject
Marks
Obtained
Maximum
Marks
(14) Details of Examination passed till date:
Examination
Roll No.
Year of
Passing

Board/University

Marks
(%)

Division

- 2Application is required to write in BOLD LETTERS his/her name and address for correspondence in two labels provided hereunder,
mentioning Application Form No. on each labels.
Application Form No. .
Name ...
Address

Pin Tel ..
Mobile No E-mail: ...

Application Form No. .

Name ...
Address..

Pin Tel ..
Mobile No E-mail: ...

(14a) Details of intervening period if any (attach documentary evidence in support thereof, as specified in the Guide).
(a) No. of years for which studies were discontinued ___________________________________________
(b) Details of utilization of intervening period ________________________________________________
(14b) visible Identification Marks of the candidate _____________________________________________________
(15) Declaration by the candidate:
I am neither involved in my criminal case nor is any criminal case pending against me in any court of law. I have not been debarred/ rusticated by the
institution last attended/presently attending. If discovered even after confirmation of my provisional admission that I have made a false or incorrect
statement or concealed any fact or used fraudulent means or such means have been used on my behalf for securing admission. I shall be liable to
disciplinary action and cancellation of my admission without prejudice to such actions as University may take against me. I have enclosures
_______________________including crossed Demand Draft/Cash Receipt (give number of enclosures in words) with this application form for
admission.
I also promise and undertake that in future also, if the University decides to carry out any further investigation / medical test for the verification of
my identity, I shall not oppose rather cooperate with the university in doing so, failing which the university shall have the right to cancel my Entrance
Test / Admission on this ground and any other ground.
I_________________________________________ hereby solemnly declare on oath that the entries made by me in the above columns are true to the
best of my knowledge and behalf and if any time, the entries are found incorrect, the admission may out righty be rejected and disciplinary action
may be initiated against me.

PARMANENT ADDRESS________________________
________________________
P.O./City _____________________________________
District _______________________________________
Telephone No. with STD code _____________________
(16) Information for statistical purpose

_____________ Thumb
impression of the candidate
Male (LTI). Female (RTI)

Signature of the candidate

Dated _________________

Signature of Parent/Guardian____________
Relationship with Applicant___________________
Place_____________Dated: __________________

(a) Community/ Religion ________________________. Sunni/Shia ____________________

(b) SC/ST/OBC________
(c)Rural/Urban __________________________________ Mother Tongue __________________________________________
(d) Fathers Guardians monthly income Rs______________________ per annum
(e) Occupation _______________ (f) Married/Unmarried _____________ (g) Employee/Non-Employee____________________

(17) CHECK LIST: All the attached enclosures should be arranged serially as per following check list with Application form.
Note Original Certificates/documents not be attached with the application form in any case.
For Office Use
For
1.Self addressed stamped Acknowledgement Card.
Verified Original Documents.
Office
2.Crossed Demand Draft/Cast Receipt
The candidate is eligible for
Use
3.Attested Copy of HS/SSC in support of date of birth.
admission
to
____________.
4.Attested copies of Marksheet/Gradesheet of qualifying examination
Remarks ________________
5.______________________________________________
________________________
6.______________________________________________
________________________
Verifying Officer _________
7.______________________________________________
Dept. of _________________
Dated __________________
(18) Admitted to _______________ Class/Course and allotted Faculty Roll No____________________
Dated: _______________________
DIRECTOR, CDE
_______________________________________________________________________________________________
For office use only:
(19) Admission completed on ___________and entered in Admission Register No. ____________ Page No. _____ and attached to
_________________________________________________________________ Study Centre.
Dealing Assistant
Dated ________________

Director/Assistant Director
Dated______________