JAMIA HAMDARD
HAMDARD NAGAR, NEW DELHI - 110062
APPLICATION FORM FOR ADMISSIONS
SCHOOL OF OPEN AND DISTANCE LEARNING (FOR DISTANCE EDUCATION PROGRAMME)
This form can also be downloaded from www.jamiahamdard.edu
IMPORTANT INSTRUCTIONS:1. Read the PROSPECTUS carefully before filling in the form.2. Please fill in all the entries in CAPITAL LETTER using a BALL POINT PEN only3. Do NOT STAPLE/PIN ANY DOCUMENT WITH THIS FORM. (Use Clip)4. Applica�on form with incomplete informa�on and without perscribed fee will not be processed.5. Write in CAPITAL LETTERS only within the box without touching the line as shown in the sample below.
0 1 2 3 4 5 6 7 8 9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
Programme of Study (Write programme Code in the boxes as given in the prospectus)
FORM NUMBER:
1. Programme Code 2. Processing Fee Enclosed 3. Study Centre Jamia Hamdard 4. Employed?
Rs. (See Prospectus for Codes)A1 = Employed B2 = Unemployed
5. Personal Details
Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle and Last Names)
Date of Birth Religion SC/ST Gender State of Domicile Area
DAY MONTH YEAR (See Prospectus for Codes for filling in the boxes shown above.)
Father’s Name (Use CAPITAL LETTERS only. Leave a blank box between First, Middle and Last Names)
Country Name Permanent Address PIN Code
6. Qualifying Exam Details (See Prospectus for Codes)
QualifyingExam Code
Board/University Code
Year of Passing/Appearing
Percentage
7. Photograph 8. Write Name & Complete Mailing Address with Black Ball Point Pen
Paste yourphotograph
within this boxDO NOT STAPLE
Name :
C/o
Phone No. :
E-mail ID :
PIN CODE
9. Candidate’s Signature
(For office use)
Academic Year
(Deemed University Under Section 3 of UGC Act 1956)
JA DM RIA A H DAM
25001
10. Details of Examina�on Passed
Examina�on Name of School / College & Place
Board / University Subjects Year of
Passing Percentage
or Grade
High School (Class X)
10+2/Intermediate
Gradua�on (Write the name of the degree)
Post Gradua�on
Any Other
11. Mother’s Name
12. Permanent Address
DISTRICT
STATE PIN CODE
COUNTRY
13. Are you a son/daughter/spouse of Jamia Hamdard Employee? (If yes, a cer�ficate from the Registrar showing the rela�onship should be submi�ed in the office of the Director, School of Open and Distance Learning personally.)
14. Details of Dra�
Dra� Number and Date Amount Drawee Bank
DECLARATION BY THE APPLICANT
I..................................................................... S/o or D/o .................................................................. declare that the statements given in this
applica�on form are true to the best of my knowledge. I understand that if any of the statements are found wrong, my admission will stand cancelled.
If admi�ed, I will abide by the rules and regula�ons in force in Jamia Hamdard and as amended from �me to �me and pay the prescribed fees.
Date: ............................ Signature : ...........................................................
Name : ...........................................................
YES NO
I Year
II Year
III Year
IV Year
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