Dear Sir, I hereby apply for admission to the course ----------------------------------------------------------------------------------------

In English

In English

In English

International Institute of Mass Media payable at New Delhi

Stream/Art, Science, Commerce

Class x Class XII Graduation Post Graduation

DECLARATION I hereby solemnly affirm that the statements made and the information furnished by me in this application form are true and correct to the best of my knowledge and belief. Should it, however, be fond that any information furnished herein is fraudulent, incorrect or untrue in material particulars; I realize that I am liable for criminal prosecution, and that my admission to the course applied for is liable to be cancelled. I agree to abide by the rules and regulations governing the examination and as contained in this bulletin of information. Signature of the Applicant Date I have fully read and understood the information furnished by my son/daughter/ward and affirm that, if it is proved that the information or any part thereof is fraudulent. I shall be liable for criminal prosecution. Signature of the Father/Mother/Guardian Date UNDERTAKING-1 (Compulsory for all applicants) I,.., s/o / d/o ., do hereby undertake that my behavior and conduct in the Institute premises, with fellow students, administrative staff and faculty members will be good. In case it is found to the contrary, the Institute administration is fully entitled to cancel my candidature and expel me from the Institute.

Signature of the Applicant Date UNDERTAKING-2 (Only for those candidates who have appeared in the qualifying examination, and the results of which have so far not been declared) I,.., s/o / d/o ., do hereby undertake that I have appeared in the examination conducted by the .Board/University held in I am seeking admission to the course at my own risk and responsibility, and I will submit the proof of my having successfully passed the qualifying examination which is required for admission to the course applied for by November 30, failing which my candidature for the same shall stand automatically cancelled and I shall make no claim whatsoever in any court of law on my aacount. Signature of the Applicant Date