JAMIA HAMDARD

HAMDARD NAGAR, NEW DELHI - 110062

APPLICATION FORM FOR ADMISSIONS

SCHOOL OF OPEN AND DISTANCE LEARNING (FOR DISTANCE EDUCATION PROGRAMME)

This form can also be downloaded from www.jamiahamdard.edu

IMPORTANT INSTRUCTIONS:1. Read the PROSPECTUS carefully before filling in the form.2. Please fill in all the entries in CAPITAL LETTER using a BALL POINT PEN only3. Do NOT STAPLE/PIN ANY DOCUMENT WITH THIS FORM. (Use Clip)4. Applica�on form with incomplete informa�on and without perscribed fee will not be processed.5. Write in CAPITAL LETTERS only within the box without touching the line as shown in the sample below.

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

Programme of Study (Write programme Code in the boxes as given in the prospectus)

FORM NUMBER:

1. Programme Code 2. Processing Fee Enclosed 3. Study Centre Jamia Hamdard 4. Employed?

Rs. (See Prospectus for Codes)A1 = Employed B2 = Unemployed

5. Personal Details

Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle and Last Names)

Date of Birth Religion SC/ST Gender State of Domicile Area

DAY MONTH YEAR (See Prospectus for Codes for filling in the boxes shown above.)

Father’s Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle and Last Names)

Country Name Permanent Address PIN Code

6. Qualifying Exam Details (See Prospectus for Codes)

QualifyingExam Code

Board/University Code

Year of Passing/Appearing

Percentage

7. Photograph 8. Write Name & Complete Mailing Address with Black Ball Point Pen

Paste yourphotograph

within this boxDO NOT STAPLE

Name :

C/o

Phone No. :

E-mail ID :

PIN CODE

9. Candidate’s Signature

(For office use)

Academic Year

(Deemed University Under Section 3 of UGC Act 1956)

JA DM RIA A H DAM

25001

10. Details of Examina�on Passed

Examina�on Name of School / College & Place

Board / University Subjects Year of

Passing Percentage

or Grade

High School (Class X)

10+2/Intermediate

Gradua�on (Write the name of the degree)

Post Gradua�on

Any Other

11. Mother’s Name

12. Permanent Address

DISTRICT

STATE PIN CODE

COUNTRY

13. Are you a son/daughter/spouse of Jamia Hamdard Employee? (If yes, a cer�ficate from the Registrar showing the rela�onship should be submi�ed in the office of the Director, School of Open and Distance Learning personally.)

14. Details of Dra�

Dra� Number and Date Amount Drawee Bank

DECLARATION BY THE APPLICANT

I..................................................................... S/o or D/o .................................................................. declare that the statements given in this

applica�on form are true to the best of my knowledge. I understand that if any of the statements are found wrong, my admission will stand cancelled.

If admi�ed, I will abide by the rules and regula�ons in force in Jamia Hamdard and as amended from �me to �me and pay the prescribed fees.

Date: ............................ Signature : ...........................................................

Name : ...........................................................

YES NO

I Year

II Year

III Year

IV Year

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