Reg No........................... ? Ç e î ¡ ` ` ` ` ` d G ~ ¾ Á ` ` ` ` d G ? © e ? Ö ? © H ? ? d G ? © j ? ¡ ? ` ` ` ` ` ` ` d G ? Ç ¸ ` ` ` ` ` ` c SHAREEA COLLEGE MALAPPURAM JAMIA CAMPUS, MINI OOTTY, P.O. OORAKAM, MELMURI, MALAPPURAM DT, KERALA, 676 519, INDIA, Mob: 91 9961725725, 91 9847592150, 91 8086 216 625 www.jamiaalhind.com, [email protected] APPLICATION FORM 1 A) Name of applicant in English (in block letters as in SSLC book) b) In regional language c) Expansion of Initial 2 a) Name of Father / Guardian b) Relationship with Guardian c) Occupation d) Name of Mother 3 a) Address for Communications Pin: Phone: b) Distance from residence 4 Age and Date of Birth (In figures and words) 5 Sex 6 Nationality / Mother tongue / Religion 7 Course selected 8 Name of Course and Institution the applicant last attended 9 Whether qualified for promotion 10 T.C. No. and Date 11 Details of qualified examination 12 No. of chances taken 13 First language for SSLC Examination Male / Female Yes / No a) Reg. No. Paper I Paper II b) Year 14 a) Details regarding the qualifying examination Name of Paper / Subject Mark Obtained Maximum Marks b) Passed / Failed 15 Other eligibilities :…………................................................................................................……………………………. Arts 16 IT Sports Other Have you studied in any Hostel :............................................................................................................................... If yes, Mention the details :........................................................................................................................................ 17 Your hobbies :............................................................................................................................................................ 18 Family Details (Name, Age, Educational qualification and are they alive or dead) Father :..................................................................................................................................................................... Mother :..................................................................................................................................................................... Brother :..................................................................................................................................................................... Sister :..................................................................................................................................................................... 19 Blood Group …………. 20. If any Physical disabilities :........................................................................................... 21 The main Islamic Books you have read :.........................................…………………………...................................... 22 Name of important personalities in your place : 1…………..............…………………….. Ph:……………………...... 1…………..............…………………….. Ph:……………………...... 23 Certificates submitted with the application :……….........................................................................………………….. DECLARATION BY THE APPLICANT I here by declare that the entries made above are correct and true, If selected, I will obey the rules and regulations of the institution Date Place Name and Signature of the Applicant DECLARATION BY THE PARENT I request that………………………………………… ........................................................................................................... Who is under my responsibility and control may pleased to be admitted in your institution and I Do hereby Declare that the rule and regulations of the institution will be abide by him / her Date Place Name and Signature of the Parent FOR OFFICE USE ONLY Course and class admitted :…..…………..................…...........……………. Admission No.:…..........................……….. Date of admission :…………..……………………….............................................………………...……………………….. Certificates received :..........…………………………………………………………………....................................……….. Details of Fee remitted at the time of Admission :……………………………………….................................................... Signature of the Principal