JAMIA MILLIA ISLAMIA Price : Rs.

200/-
Jamia Nagar, New Delhi-110025 Form No.
Application Form for admission to
M.Phil./ M.Sc. Tech./ M.Tech./ M.A./ M.Sc./ M.Com/ M.I.B./ LL.M./MPT
B.A., LL.B./ BPT/ B.Lib./ P.G.Diploma/ Adv. Diploma/
Diploma and Certificate Courses 2011-2012
Roll No. Affix your recent
(To be filled in by the office) self attested coloured
photograph
• Read the instruction given overleaf and in the prospectus carefully before filling up this form.
(Size 2.0 x 1.5)
• All the particulars must be filled in by the candidate in his/her own hand writing.
It should be pasted with gum
• Applicant must ensure minimum eligibility conditions before applying. and covered with
• Submission of Application form will be no basis for claiming admission. transparent tape
• Do not attach copies of mark sheets, certificate etc. with this form, Original document with
attested copies alongwith Hall Ticket for Entrance Test shall be required at the time of interview.
• Incomplete application form will NOT be considered.

1. Application for admission to. ...............................................................................................................................

2. Faculty.............................................................................................................Deptt.........................................

3. Category (See instruction no. 2 overleaf for category code).....................................................................................

4. Name :
(In block letters)
5. Father’s Name :
(In block letters)
6. Mother’s Name :
(In block letters)
7. Father’s Occupation............................................................................................................
8. Address : (i) Present (for correspondence) (ii) Permanent
.......................................................................................... ........................................................................
......................................................................................... ........................................................................
State................................................................................. State................................................................
Pin..............................Telephone No.............................. Pin........................Telephone No.......................
9. Date of birth : (Based on Matriculation/Sec.School Certificate) Nearest Railway Station.....................................
Date : Month : Year : Age : (As on 1/10/2011)
10. Nationality :..............................................
11. Sex M F
12. Educational Qualifications :
S.No Exams. Passed Board/ Year Division Agg.% Subject % of required
University Studied Subject (s)
1. Matric/ S.S.C
2. Intermediate/Sr.School
Certificate
3. B.A./B.Sc./B.Com
4. M.A./M.Sc./M.Com/LL.M.
5. Others
13. Post Graduate Courses : Choice of specialization, if any : .................................................................................
14. DD No...................................................... Date ...........................................
(Note: The Demand Draft for Rs. 200/- should be in favour of Jamia Millia Islamia, payable at New Delhi)

Date................... Signature of Applicant.....................................

 JAMIA MILLIA ISLAMIA Form No.

Jamia Nagar, New Delhi-110025 Roll No.

Hall Ticket for Entrance Test 2011-2012 (To be filled by the office)

Course(s) applied for: ................................................. Dept./Faculty .............................

Name (In Block Letters):........................................................................................................... Affix your recent
FOR CENTRE

Father’s Name:.................................................................................................................. self attested coloured

photograph
Mother’s Name:.................................................................................................................
(Size 2.0 x 1.5)
Address:............................................................................................................................
It should be pasted with gum
and covered with

....................................... ....................................... transparent tape

Signature of Applicant Signature of Invigilator

 Cut Here 
Form No.
JAMIA MILLIA ISLAMIA
Jamia Nagar, New Delhi-110025 Roll No.
Hall Ticket for Entrance Test 2011-2012 (To be filled by the office)
FOR CANDIDATE

Course applied for:................................................. Dept./Faculty .................................

Name (In Block Letters) : .......................................................................................................... Affix your recent
self attested coloured
Father’s Name:..................................................................................................................
photograph
Mother’s Name:................................................................................................................. (Size 2.0 x 1.5)
Address:............................................................................................................................It should be pasted with gum
and covered with
transparent tape
....................................... .......................................
Signature of Applicant Signature of Invigilator
Note: (i) Contact the Concerned Dept /Faculty for venue of Entrance Test.
(ii) Retain this Hall Ticket with you. It will have to be produced at the time of Entrance Test and
Interview.

 Cut Here 
Form No.

Received an Application Form from (Candidate Name) ............................................................ for admission

to ................................................................................................course.

.............................................
Date................................. Signature of receiving official
 DECLARATION
I SOLEMNLY UNDERTAKE to accept and abide by the rules of the Jamia Millia Islamia and all the decisions of the
Admission Committee and other appropriate University bodies in regard to my admission.
I SOLEMNLY AFFIRM that I have never been convicted by a court of law nor rusticated/expelled from any educational
institutions/nor disqualified/debarred from any examination.
I will accept the cancellation/forfeiture of my candidature in case any information supplied by me in this form is found to be
incorrect at the time of admission or thereafter.

Date................................... Signature of the Applicant

DECLARATION BY THE PARENT/GUARDIAN

I certify that the above particulars are correct. I agree that in the event of my son/daughter/
ward............................................................. being admitted to the Jamia Millia Islamia, New Delhi. I shall pay dues
and all personal expenses until the completion of the applicant’s studies. I also undertake full responsibility for the good
behaviour and conduct of the applicant.

Date.............................. Signature in full of the Parents/Guardian

Relation with student.....................................................
Address.......................................................................
...................................................................................
Telephone No................................................................
E-mail..........................................................................

INSTRUCTIONS

1. Code for Category:

G General J Jamia Student S Scheduled Caste
T Scheduled Tribe P Persons with Disabilities K Kashmiri Migrant
No change of category is permissible, once the choice has been made.

2. Bank draft/Pay order (of a bank having its branch in New Delhi) should be made in favour of Jamia Millia Islamia,
payable at New Delhi. Candidate must write his/her name and number of his/her application form on the back of the
bank draft/pay order/cash receipt on top left conrner.

3. Filled Application Form complete in all respect should be submitted in the office of the respective Faculty/Department/
Centre by the last date indicated in the Prospectus.