Anda di halaman 1dari 1

Application No: 40274109/SCXX

General
Selected/Chance Memo/
Special Category Rank
ALIGARH MUSLIM UNIVERSITY
ONLINE PAYMENT

Session: 2019 - 2020 Roll No. : 0


Application Form for admission to
XI Science & Diploma in Engineering
Senior Secondary Schools/Polytechnic

Bank: 1730, CR No./Online Txn No.: 730788953, Date: 2019-03-02 16:42:16, Amount: 550 Nationality: INDIAN

Course Applied for : Medium of Test Paper :


__________________________________________________________________________________________________
XI SCIENCE & DIPLOMA (BOTH) HINDI
Preference for Test Centres:
__________________________________________________________________________________________________
1. Patna 2. Kolkata
Personal Details:
__________________________________________________________________________________________________
ONLINE PAYMENT

Name: FAISAL ALI Father's Name: ZAKIR HUSSAIN


Date of Birth: 22-11-2003 Mother's Name: HUSNE ARA KHATUN
Gender: MALE
Religion: Islam

Details of Qualifying Examination: Status & Special Categories:


__________________________________________________________________________________________________
Examination: MATRIC APPEARING Status: External
Enrolment No.:
Roll No.: 1900059
Hall:
Year of Passing/Appearing: 2019 Special Categories: 1. NA 2. NA 3. NA
Board/Univ.: Bihar School Examination Board, Patna
Marks Obt./Max. Marks: 0/0
Remarks (if any):

Name of the Examination Board/University Year Roll No. % of Marks


MATRIC BSEB PATNA 2019 1900059 NA
ONLINE PAYMENT

Permanent Address: Address for Correspondence:


__________________________________________________________________________________________________
Address: VILL:-BARWA BARAULI P/S:- SHIKARPUR Address: VILL :-BARWA BARAULI P/S:- SHIKARPUR
NARKATIAGANJ NARKATIAGANJ
WEST CHAMPARAN - 845451(BR) WEST CHAMPARAN - 845451(BR)

Phone 1: 9934220065 Phone 2: Email ID: faisalali54387@gmail.com


Is hostel accommodation required? YES (Hostel accommodation is not guaranteed; it is subject to availability of seats in the hostel)
__________________________________________________________________________________________________
DECLARATION: I SOLEMNLY UNDERTAKE to accept and abide by the rules of the Aligarh Muslim University and all the decisions of the Academic
Council & other appropriate University bodies in regard to my admission. I hereby solemnly affirm that I have gone through the Guide to Admissions &
Supplements applicable for this course and solemnly declare on oath that the entries made by me in the above columns are true to the best of my
INE PAYMENT

knowledge and belief and if at any time, the entries are found incorrect, the admission may outrightly be cancelled and disciplinary action may be
initiated against me.
Application No: 40274109/SCXX

__________________________
Signature of the Candidate
Left Hand Thumb Impression (for All candidates)

Anda mungkin juga menyukai