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Application Form For Admission To B.Tech. Only Faculty of Engineering &technology

This document is an application form for admission to the B.Tech program at Aligarh Muslim University for the 2014-15 academic session. It contains personal details of the applicant such as name, date of birth, gender, religion, family income, address, contact information, and educational qualifications. It also includes information about the applicant's preferred branches and test centers, as well as declaration of special categories if applicable. The form is filled for the applicant Tazeem Fatma and includes instructions for submitting required documents along with the application.

Uploaded by

Zafar Iqbal
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
43 views

Application Form For Admission To B.Tech. Only Faculty of Engineering &technology

This document is an application form for admission to the B.Tech program at Aligarh Muslim University for the 2014-15 academic session. It contains personal details of the applicant such as name, date of birth, gender, religion, family income, address, contact information, and educational qualifications. It also includes information about the applicant's preferred branches and test centers, as well as declaration of special categories if applicable. The form is filled for the applicant Tazeem Fatma and includes instructions for submitting required documents along with the application.

Uploaded by

Zafar Iqbal
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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For Office Use only

Transaction ID: 3032316/BTEC

ALIGARH MUSLIM UNIVERSITY


Session: 2014-15
Application Form for Admission to
B.TECH. ONLY
FACULTY OF ENGINEERING &TECHNOLOGY

Bank: STATE BANK OF INDIA, DD/CR No.: 173113, Date: 2014-03-15, Amount: 500

Affix (don't staple)


Self Attested
Photograph of
size 2.5 x 3cm

Nationality: INDIAN

Order of Preference of Branches:


__________________________________________________________________________________________________
1. COBT 2. LEBT 3. EEBT 4. KEBT 5. PKBT 6. CEBT 7. MEBT 8. -- 9. -Preference for Test Centres:
__________________________________________________________________________________________________
1. LUCKNOW 2. ALIGARH

Personal Details:
__________________________________________________________________________________________________
Name: TAZEEM FATMA
Date of Birth: 09-05-1996
Gender: FEMALE
Religion: ISLAM

Father's Name: ASGHAR ALI


Mother's Name: ABDA TABASSUM
Parent's/Guardian's Monthly Income: 5000
Rural/Urban: URBAN

Details of Qualifying Examination:


Status & Special Categories:
__________________________________________________________________________________________________
Examination: ISC
Roll No.: 5496334
Year of Passing/Appearing: 2014
Board/Univ.: 526
Marks Obt./Max. Marks: /
Remarks (if any): RA

Status: EXTERNAL
Enrolment No.:
Hall:
Special Categories: 1. BC 2. -- 3. --

Course(s) Studied/Studying other than Qualifying Examination (Starting from the latest):
__________________________________________________________________________________________________
Course

Yr. of Passing/Appearing

ICSC

2012

Board/Univ.

526

Roll No.

T/3396/091

Permanent Address:
Address for Correspondence:
__________________________________________________________________________________________________
Address: 529 KHA/4B/1 ,SANT KABEER LANE
MATEENPURA KHURRAMNAGAR
LUCKNOW - 226022(UP)

Address: 529 KHA/4B/1 ,SANT KABEER LANE


MATEENPURA KHURRAMNAGAR
LUCKNOW - 226022(UP)

Phone 1: 9450001786

Email ID: [email protected]

Phone 2: 9450001786

If admitted, is hostel accomodation required? YES


__________________________________________________________________________________________________
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
2014-15 and solemnly declare on oath that the entries made by me in the above columns are true to the best of my 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.
Transaction ID: 3032316/BTEC
15/03/2014-06:07

Thumb Impression
Male: Left Thumb, Female: Right Thumb

__________________________
Signature of the Candidate

FOR OFFICE USE ONLY

List of enclosures attached with the Application Form:

1.

DD/Cash Receipt in Original

2.

Self Attested copy of HS/SS Certificate in support of date of Birth

3.

Copies of Marksheets/Grade Sheets of all previous Examinations


passed/appeared including parts therein after passing High School

4.

If employed, copy of No Objection Certificate from the employer

5.

Copy of documents in support of Special Categories clamied, if any

6.

Copy of document(s), if rusticated/debarred or convicted by a court of law

____________________________________

7.

________________________________________

Remarks ____________________________

8.

________________________________________

Signature of Scrutiny Officer


Identity & Original Documents Verified
The candidate is eligible/not eligible for admission to

Verifying Officer ____________________

Hall Allotted:

Dept. of ___________________________
Date ____________________
Clearance by Proctor

DSW

Address Slips (for Office Use):

--------------------------------------------------------------------------------------------------------------------------------------Name: TAZEEM FATMA


Name: TAZEEM FATMA
Address: 529 KHA/4B/1 ,SANT KABEER LANE
Address: 529 KHA/4B/1 ,SANT KABEER LANE
MATEENPURA KHURRAMNAGAR
MATEENPURA KHURRAMNAGAR
LUCKNOW - 226022(UP)
LUCKNOW - 226022(UP)
Tel./Mobile: 9450001786
Tel./Mobile: 9450001786
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name: TAZEEM FATMA
Name: TAZEEM FATMA
Address: 529 KHA/4B/1 ,SANT KABEER LANE
Address: 529 KHA/4B/1 ,SANT KABEER LANE
MATEENPURA KHURRAMNAGAR
MATEENPURA KHURRAMNAGAR
LUCKNOW - 226022(UP)
LUCKNOW - 226022(UP)
Tel./Mobile: 9450001786
Tel./Mobile: 9450001786
---------------------------------------------------------------------------------------------------------------------------------------

Transaction ID: 3032316/BTEC

Aligarh Muslim University


Scan Card, 2014-15
B.TECH. ONLY

(For Office Use only)

Affix (don't staple)

Name: TAZEEM FATMA


Address:
529 KHA/4B/1 ,SANT KABEER LANE
MATEENPURA KHURRAMNAGAR
LUCKNOW - 226022(UP)
Tel./Mobile: 9450001786

NON-ATTESTED
Photograph of
size 2.5 x 3cm

Thumb Impression
Male(Left Thumb)/Female(Right Thumb)
Specimen Signature of the candidate

ACKNOWLEDGEMENT SLIP, AMU, Aligarh


Application form for admission to:
B.TECH. ONLY, 2014-15
has been received.
App. No. is: _____________________
Transaction ID: 3032316/BTEC

To,
Name: TAZEEM FATMA
Address: 529 KHA/4B/1 ,SANT KABEER LANE
MATEENPURA KHURRAMNAGAR
LUCKNOW - 226022(UP)
Tel./Mobile: 9450001786

POSTAL SLIP
Application Form for Admission to
B.TECH. ONLY

To,
ASSTT./DY. CONTROLLER (ADMISSIONS)
ADMISSION SECTION, AMU,
ALIGARH - 202002 (UP)
From:
Name: TAZEEM FATMA
Address: 529 KHA/4B/1 ,SANT KABEER LANE
MATEENPURA KHURRAMNAGAR
LUCKNOW - 226022(UP)
Tel./Mobile: 9450001786

--------------------------------------------------------------------------------------------------Aligarh Muslim University


CANDIDATE'S SLIP

(Keep this Slip with you for future reference)


Course Applied for: B.TECH. ONLY
Transaction ID: 3032316/BTEC
Password: 1996-05-09
_______________________________________________________________________________

INSTRUCTIONS
1. Please ensure that you have appended Photographs, Thumb Impression and Signature at the designated places on
the Application form.
Note: a) Use identical good quality color photographs taken not earlier than 3 months. The photographs should be taken preferably
wearing dark clothes on a white background.
b) Your Thumb Impression & Signature establish your identity hence, do not merely write your name in capital letters.

2. You must Ensure that all the documents along with Demand Draft/Cash Receipt is attached with the Application
Form.
Note: Demand Draft (valid for 3 months) of the requisite amount should be drawn in favor of FINANCE OFFICER, AMU, payable at
Aligarh.

3. You must NOT make any type of correction(s) / modification(s) on the Application Form else your candidature may be
rejected.
4. Paste the POSTAL SLIP given above on the A-4 size Envelope containing the Application Form and send it on the
Pre-Printed Address.
5. Please be a regular visitor to our website: www.amucontrollerexams.com which will provide you with necessary
updates regarding the status of your Application Form/Admission Test results etc.

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