3/22/2020

Application for Bachelors (2020-21)

REGISTRATION NO: JMI00350114B07 PAYMENT ID: JMI5e76fd7f51a0a946

AAdhar No: 429630346673

Course Name: B.Sc (Bio Sc./Bio-Tech)
‫ ﮐورس ﮐﺎ ﻧﺎم‬/ पाठय म का नाम :
Candidate Name: MARZOOQA MUZAFFAR
‫ درﺧواﺳت ﮔزار ﮐﺎ ﻧﺎم‬/आवेदक का नाम
:
Father's Name: Md. Mozaffarul Islam
‫ واﻟد ﮐﺎ ﻧﺎم‬/ िपता का नाम :
Mother's Name: Mehbuba Rehman
माता का नाम:
Father's / Mother's / Spouse (if 9434681398
married) Mobile Number:
‫ واﻟده ﮐﺎ ﻣوﺑﺎﺋل ﻧﻣﺑر@واﻟد‬/िपता / माता
का मोबाइल नंबर :
Date of Birth: 12 March, 2000
‫ ﺗﺎرﯾﺦ ﭘﯾداﺋش‬/ ज ितिथ :

Sex/‫ ﺟﻧس‬/िलंग: Female Social Category/‫ﮐﻼس‬/वग: GENERAL

Blood Group: O+ Kashmiri Migrant?: No

‫ ﺑﻠڈ ﮔروپ‬/ ड ुप : Are you from Jammu and Kashmir?: No
Nationality/‫ﻗوﻣﯾت‬//रा ीयता : Indian N.C.C. Cadets: No
Religion/‫ﻣذﮨب‬/धम: ISLAM N.S.S. Volunteers: No

Address For Correspondence प ाचार का पता Permanent Address थायी पता

Name: MARZOOQA MUZAFFAR Guardian's Name (If Md. mozaffarul islam
‫ درﺧواﺳت ﮔزار ﮐﺎ ﻧﺎم‬/ आवेदक Applicable)
का नाम
Address / ‫ ﭘﺗہ‬/पता : 95/101/77, ghoshpara, bibigram
Address / ‫ ﭘﺗہ‬/पता : 95/101/77, ghoshpara, bibigram
Near surya das oil mill
Near surya das oil mill

District / ‫ ﺿﻠﻊ‬/िजला: Malda

District / ‫ ﺿﻠﻊ‬/िजला: Malda
State / ‫ رﯾﺎﺳت‬/ रा : West Bengal
State / ‫ رﯾﺎﺳت‬/ रा : West Bengal
Pin / ‫ ِﭘن‬/ िपन: 732101
Pin / ‫ ﭘِن‬/ िपन: 732101
Ph. No. with STD Code
Ph. No. with STD Code
Fax No.
Mobile No./‫ﻣوﺑﺎﺋل ﻧﻣﺑر‬/ (+91) 9434681398
मोबाइल नंबर: Mobile No./‫ﻣوﺑﺎﺋل ﻧﻣﺑر‬/ (+91) 9434681398
मोबाइल नंबर:
Email marzooqamuzaffar@gmail.com

Annual Income of your Parents/Guardians in Rs. Between 2 to 6 lacs

ACADEMIC RECORD
Name of the Examination Board / University Year of Passing School Name/College Max Marks Marks Marks CGPA
/ Appearing Obtd. %

(10+2)th std. West Bengal Council of Higher Secondary 2018 BARLOW GIRLS' HIGH SCHOOL 500 452 90.4
Education, Calcutta

Reservation Category Muslim Women

Test Center Preference परी ा के व रयता

Preference - 01 DELHI

Course Preference
Preference - 1 B.Sc. Biotechnology
Preference - 2 B.Sc. Biosciences

Signature Uploaded by
the candidate/ ‫ﺑذرﯾﻌہ اﻣﯾدوار‬
‫ ا َﭘﻠوڈﯾڈ دﺳﺗﺧط‬/ अ थ ारा
अपलोडे ड ह ा र

It is hereby confirmed that I have carefully read the concerned Information Bulletin available on the JMI's Entrance Test Portal (www.jmionline.in) before filling up the Application Form.
I hereby solemnly affirm that the information furnished in this Online Application Form is true and correct to the best of my lnowledge and belief and no material information has been concealed
or suppressed. If any information is found to be false, incorrect or misleading, the Jamia Millia Islamia shall have the authority to cancel my candidature / admission without any further enquiry
or notice.
I undertake that, if admitted, I shall abide by the UGC Regulations on Curbing the Menace of Ragging, 2009, Ordinances governing the discipline of students of Jamia Millia Islamia and such
other Rules, Ordinances and Regulations that may be framed by the Jamia Millia Islamia/ UGC from time to time.
I further undertake that the preference for the Test center, Courses, Domicile and the categories to which I belong as indicated by me in the online application form shall be irrevocable.

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