3/13/2018 JAMIA MILLIA ISLAMIA (SCHOOL)

JAMIA SCHOOL ENTRANCE TEST

CHANGE PASSWORD SIGNOUT

Jamia School Entrance

Dashboard  Application Form View WELCOME SALIK AZEE

Application for Class IX

Choice of School - 01: Jamia Sr. Secondary School

Choice of School - 02: Syed Abid Husain Sr. Secondary School (S/F)
Social Category: OBC
Kashmiri Migrant: NO
Are you from Jammu & NO
Kashmir?:
Medium for ENGLISH
Examination:
Test Center Choice: PATNA
Reservation Category: Muslim OBC/ST
Candidate Name: SALIK AZEEM
Father's Name: MD AZEEM UDDIN
Mother's Name: TABASSUM PERWEEN
Guardian's Name (If SHAAD AZEEM
any)
Gender: MALE
Nationality Indian
Date of Birth: 21. August .2004
Blood Group: O+

Permanent Address Address for Correspondence

Address Line: HAZI CHOWK Address Line: HAZI CHOWK
AZAD NAGAR AZAD NAGAR
WARD NO 19 WARD NO 19
District: Araria District: Araria
State: Bihar State: Bihar
Pin: 854311 Pin: 854311
Land Line No. Land Line No.
Mobile No. 7992318253 Mobile No. 7992318253

ACADEMIC RECORD
Last Examination Passed Year Institution / Board English % Maths % Science Aggregate %
P.C.B %
Class VIII (for IX) 2018 CBSE 0 0 0 0

School last attended : ARARIA PUBLIC SCHOOL ARARIA

I hereby declare that all the particulars given in this application form by me are true and no fact has been suppressed or tempered. I have read the information bulletin for the SET 2018 and the
terms and conditions given therein and satisfied myself that I fulfill all the admission eligibility requirements. In case any information furnished by me is found wrong, my candidature for the
entrance test be cancelled outright without giving any opportunity and further that any disciplinary action be also taken against me.

Countersigned by the Full Signature of the

Parent/ Guardian candidate

I CONFIRM THE ABOVE

PLEASE REVIEW THE ABOVE DETAILS CAREFULLY FOR ANY ERRORS BEFORE CONFIRMING SUBMISSION.

YOU WILL NOT BE ABLE TO MAKE ANY CHANGE AFTER CONFIRMATION OF SUBMISSION
THE FORM WOULD BE CONSIDERED SUCCESSFULLY SUBMITTED ONLY AFTER PAYMENT OF APPLICATION PROCESSING / ENTRANCE TEST FEE

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3/13/2018 JAMIA MILLIA ISLAMIA (SCHOOL)

JAMIA SCHOOL ENTRANCE TEST

CHANGE PASSWORD SIGNOUT

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Jamia School Entrance

Dashboard  Application Form View WELCOME SALIK AZEE

https://jmi.ucanapply.com/EntranceSCH/entrance/application-form-view?app-id=UElZMDAwMDAwNw==&cant-id=UElZMDAwMDAwNzAwMDAxNjc0N… 2/2