NIMS UNIVERSITY

Established under NIMS UNIVERSITY ACT, 2008 and recognized by UGC.

FACULTIES: Medicine Dentistry Engineering Advanced Engg. Management Law Pharmacy Nursing Science & Technology Physiotherapy Allied Health Sciences Fashion Media Mass Comm. Hospitality Aviation Education Library Sciences Physical Education Films & Television etc. multi-specialty 1000-bedded tertiary level Hospital on campus

NIMS UNIVERSITY: AN ISO 9001 : 2008 CERTIFIED ORGANIZATION APPLICATION FORM FOR ADMISSION ACADEMIC YEAR 2012-13
Name of Course: Specialization (if any): 1. .. .. Paste Recent Photograph (Do not Staple or Pin)

To be filled in CAPITAL letters only Candidates Name (As given in Class 10th Certificate):

2. 4.

Date of Birth: D D M M Y Y Y Y Marital Status: GEN Single / Married SC ST OBC

3. 5. Nationality:

Gender:

6. Category: 7.

OTHERS

(a) Fathers / Guardians / Husbands Name:

(b) Mothers Name:

8. 10.

Fathers/ Guardians/ Husbands Occupation: Permanent Address:

9.

Annual Family Income (Rs.)

STD Code E-mail ID 11.

Landline No.

Mobile No.

Correspondence Address (if different from above):

STD Code E-mail ID

Landline No.
Campus Address:

Mobile No.
Phone: (01426)-513102, 513103 Fax: (0141)-2605050, Mobile: 09799418000, 9799437000, 9829051020 Email:admission@nimsuniversity.org Web: www.nimsuniversity.org

NIMS UNIVERSITY
Shobha Nagar, Delhi Highway Jaipur-303121 (Rajasthan)

NIMS UNIVERSITY
Established under NIMS UNIVERSITY ACT, 2008 and recognized by UGC. NIMS UNIVERSITY: AN ISO 9001 : 2008 CERTIFIED ORGANIZATION 12. Educational Qualification (Start from the highest qualification first):
Name of Board / University Year of Passing Name of School / College / Institution Overall Marks (% or Grade) Major Subjects

Title of Degree / Qualification

DECLARATION BY THE APPLICANT

1. I hereby declare that all particulars stated in this application are true to the best of my knowledge and belief. I have read and understood all the provisions of the prospectus and agree to abide by them. In the event of suppression or distortion of any facts like educational qualification, nationality, study period etc. made in this application form, I understand that my admission / registration is liable to be cancelled at any stage. I am fully convinced with all the information given in the Information Broucher and understood all the rules and regulations. 2. That, if admitted to NIMS UNIVERSITY, I shall abide by its rules and regulations. 3. That, I am aware that for getting admission/ registration in NIMS UNIVERSITY, fee (Full/Part) and any charges (Full/Part), which I have deposited to the university shall not be refunded on any pretext. 4. That, I know that after the admission formalities are completed, If I want cancellation of my admission due to one or other reasons, or if I discontinue my study or request for cancellation of my admission from the course, even though, I have not attended any class, fee/any other charges paid by me will not be refunded to me on any pretext. 5. In the event of non-commitment / non-compliance of this declaration form, university can take any action 6. Jurisdiction of any dispute shall be Jaipur City, Jaipur only. Place:__________________ Date: __________________

Signature of Applicant

Signature of Parent/Guardian

Continuation Sheet

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NIMS UNIVERSITY
Established under NIMS UNIVERSITY ACT, 2008 and recognized by UGC. NIMS UNIVERSITY: AN ISO 9001 : 2008 CERTIFIED ORGANIZATION FOR OFFICE USE ONLY Receipt No. Date Name of the Accountant ..

Signature of the Applicant Name: .. Date: .

Signature of Parent / Guardian Name: .. Date: .

Academic Documents Required (Attach true copies duly attested by a Gazetted Officer with name, signature and stamp): o Degree/ Mark-sheets of qualifying examination o Migration/ Transfer Certificate from the last School / College / Institution o Certificate & Mark-sheet of standard 10+2 o Certificate & Mark-sheet of 10th standard o Degree / Mark-sheets / Certificates of all qualifications o Certificate for break / gap in education, if any Other Documents (Attach true copies self attested by the Applicant & counter signed by Parent/ Guardian): o Address Proof (any one of Ration Card, Driving License, Voter ID Card, Passport) o Identity Proof (any one of Ration Card, Driving License, Voter ID Card, Passport, PAN Card) o Caste Certificate (if the Applicant belongs to any category other than General)

Continuation Sheet

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