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Form No. .........................
JMI-WDAF-2015
SYED ABID HUSAIN SR. SEC. SCHOOL
Affix your recent photo
(size 2"x1.5") self attested.
Photograph should be
pasted with gum and not
stapled or pinned.
(MIDDLE SECTION)
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JAMIA MILLIA ISLAMIA
JAMIA NAGAR, NEW DELHI - 110025
2015 – 2016
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Application Form
Reg.No.
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Read the Prospectus carefully and Instructions printed overleaf before filling up this Application
Form. Incomplete Form will not be considered.
1.
Application for Class:
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Category ~æ¾G
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Male ™è
Female
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(See Code at the back)
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2.
3.
4.
Name of Candidate (in block letters):
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Father's Name x **
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Mother's Name x **
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Name of guardian (if any) x**
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6.
Nationality : è¸ ...........................................
7.
Annual Income of father or guardian (if father is not alive)
8.
State to which Candidate belongs ì m»g ZzyZÐTx **
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9.
Local Mailing Address (if any)
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10.
Permanent Address:Ø x
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..........................................................................
..........................................................................
..........................................................................
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..................... State
Pin '''' 'Phone No '''''''
Pin '''' Phone No ''''''
Nearest Railway Station (for Railway concession)
11.
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Date of Birth (in words) ( ~V/) öZa õg @
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(in figures)~VÎy :
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Year
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Place of Birth öZa x £: ''''' District I : '''''''''' State /ß : ''''''
13.
Blood Group\z¤
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Last Examination Passed ì Hk*
15.
Institution last attended { Ç½~y
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16.
Bank Draft No. '''''' Date '''' Drawn of Bank : '''''''' Rs. ''''''
Day
Month
Year w‚
Institution{ Ç½
Result ³ Grade/Percentage ‚&+
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(only for downloaded forms)
....................................................
Signature of Applicant g ZzyZ \Š
Date õg @
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SYED ABID HUSAIN SR. SEC. SCHOOL
(MIDDLE SECTION) 2015-2016
Acknowledgement Slip
Received Application Form from '''''''''''' for class '''''' on '''''''
Reg. No. '''''''''
''''''''
Dealing Asstt.
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INSTRUCTIONS
Note:
1. Category code should be given carefully. Incorrect proclamation of the category shall lead to immediate cancellation of
form/admission.
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CATEGORY ~æ 5 ´
CODE eÃ
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General
M
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Muslim
MW
''''-
Muslim Women
MO
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Muslim OBC
MT
''''
Muslim Schedule Tribe
PD
''''
Persons with Disability
KM
''''
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.
I, further declare that I am not involved in any criminal case and no such case is pending
against me in the court of law.
''''''''
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Signature of Father/Mother/Guardian
Date '''
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 2015-2016
Syed Abid Husain Sr. Sec. School (S/F)
Class
Prep
Date
Time
Place
th
14 April, 2015
10:30 a.m.
h
10:30 a.m.
th
10:30 a.m.
Multi purpose Hall,
Sr. Secondary School,
JMI
I
15 April, 2015
VI
16 April, 2015