Rs. 250/- wjZ ~g²‘@+ $¬¦ 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) 25X ‹Š5ÔôeY ÔðsZ¯eY JAMIA MILLIA ISLAMIA JAMIA NAGAR, NEW DELHI - 110025 2015 – 2016 xg à „ ZpgŠ Application Form Reg.No. ™Å XÐN YŒŠšxgÃå* *X ³, 7Ðg¨ ÿ) Zg2Š¬Ðä½xg à Read the Prospectus carefully and Instructions printed overleaf before filling up this Application Form. Incomplete Form will not be considered. 1. Application for Class: YH 4 54´ Category ~æ¾G ) )ñZ, ® ' „ ZpgŠ Male ™è Female $¸ / (See Code at the back) BŠ eÃ, 61 2. 3. 4. Name of Candidate (in block letters): ( ~szw} (, Æ~ m, ôZ )g ZzyZx ** Father's Name x ** »−Zz: Mother's Name x ** »{−Zz: 5. Name of guardian (if any) x** »„ 6, u: 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 ** »/ß:.............................................................................................. 9. Local Mailing Address (if any) $ÂzâñZ', " Øò £ 10. Permanent Address:Ø x .......................................................................... .......................................................................... .......................................................................... .......................................................................... .......................................................................... ..................... State Pin '''' 'Phone No ''''''' Pin '''' Phone No '''''' Nearest Railway Station (for Railway concession) 11. ãæW: Ñ‚Å„ 6, u* c −Zz : ''''''''''' (/ß) :........................... ($ ä } wgñZ',)øZ} wgO Š 4,: '''''''''' Date of Birth (in words) ( ~V/) öZa õg @ * : ....................................................................................................................... (in figures)~VÎy : yŠ 12. · Year w‚ Place of Birth öZa x £: ''''' District I : '''''''''' State /ß : '''''' 13. Blood Group\z¤ / ¤:................... 14. 0 yJZ Last Examination Passed ì Hk* 15. Institution last attended { ǽ~y W:...................................................................................................................................... 16. Bank Draft No. '''''' Date '''' Drawn of Bank : '''''''' Rs. '''''' Day Month Year w‚ Institution{ ǽ Result ³ Grade/Percentage ‚&+ i/ ¤ (only for downloaded forms) .................................................... Signature of Applicant g ZzyZ \Š Date õg @ *......................... SYED ABID HUSAIN SR. SEC. SCHOOL (MIDDLE SECTION) 2015-2016 Acknowledgement Slip Received Application Form from '''''''''''' for class '''''' on ''''''' Reg. No. ''''''''' '''''''' Dealing Asstt. P.T.O ]* c Z@0Ðä½xg à INSTRUCTIONS Note: 1. Category code should be given carefully. Incorrect proclamation of the category shall lead to immediate cancellation of form/admission. YH 4 ¾ G CATEGORY ~æ 5 ´ CODE eà GE '''' General M '''' Muslim MW ''''- Muslim Women MO ''''- 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. '''''''' 6, „ u&{−Zz&−Zz\Š ''''''''' g ZzyZ \Š õg @* 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
© Copyright 2024