Details of Admission Test Fee/ Processing Charges Page 1of 4

DD/C.R. No. Amount

Course Name with date (For Office use only)
(Rs.)
SSSC/ Dip. in Engg.

ALIGARH MUSLIM UNIVERSITY, ALIGARH Affix

Session: 2011-12 (Do not staple)

Application Form for Admission to Self Attested

SSSC (Science Stream)/Diploma in Engg.

Recent
Photograph of
Senior Secondary School/ Faculty of Engg. & Tech. size 2.5cm. x 3 cm.

Note: 1. Candidate opting for DPIA/DPID/DPFT will have the Admission Test Centre at ALIGARH only.
2. Age of Male candidates opting for any branch of Diploma in Engg. must not exceed 21 years on 31 st Dec. of this year
(1) Indicate the preference for combinations/branches by writing 1,2,3…. etc. (maximum choices should not exceed nine)
(FOR MALE CANDIDATES ONLY) (FOR FEMALE CANDIDATES ONLY)
P .C.B. (PCBX) H.C.B. (HCBX)
P .C.M. (PCMX)
H.C.P . (HCPX)
Dip. in Civil Engg. (DPIC)
Dip. in Civil Construction Tech. (DPCT) P .C.B. (PCBX)
Dip. in Computer Engg. (DPCE)
P .C.M. (PCMX)
Dip. in Electrical Engg. (DPIE)
Dip. in Electronics Engg. (DPEE) Dip. in Computer Engg. (DPCO)
Dip. in Instrumentation & Control (DPII)
Dip. in Mechanical Engg. (DPIM) Dip. in Electronics Engg. (DPLE)

Dip. in Mechanical Production Engg. (DPPE) Dip. in Information Technology (DPIT)

Dip. in Engg. Mech. Ref. & A.C. (DPAC)
Dip. in Plastic Tech. (DPPT)
(with an additional fee of Rs. 100)
(with an additional fee of Rs. 100)
Dip. in Architectural Assistantship (DPIA)
Dip. in Architectural Assistantship (DPIA)
Dip. in Interior Design (DPID)
Dip. in Leather & Footwear Tech. (DPFT) Dip. in Interior Design (DPID)
(2) Indicate preference for Two Admission Test centres by writing 1, 2
ALIGARH LUCKNOW PATNA
(3) Preferred Medium for Admission Test (Tick any one)
ENGLISH H INDI URDU

(4) Status (5a) Enrolment No. (5b) School Code

(Internal/External) (For candidates appearing/appeared at AMU board) (Refer to Guide to Admission)

(6) Name of the Candidate (Mr ./Ms.)

(As in HS/SS Certificate)

(7) Father’s Name ___________________________________ (8) Mother’s Name ______________________________

Day Month Year (10) Gender (M/F)
(9) Date of Birth

(11)
(i) Special Category Claimed i) ii) iii) (ii) Domicile State
(Attach Attested Certificate) (Code only)

(12) Details of Qualifying Examination (*Write RA if result is not declared)

Examination Roll No. Yr. of Passing/ Appearing Board/ Uni. Marks Max. Marks Remarks*
 Page 2of 4
(13) Details of Other Examination Passed/Appearing as on date:
Year of Passing/ Board/ Maximum
Examination Roll No. Marks
Appearing University Marks
S.S.C./High School

S.S.S.C./Intermediate

U.G (B.A./B.Sc./B.Com./......................................)

P.G. (M.A./M.Sc./M.Com./..................................)

Others (.................................................................)

(14) Is Hostel Accommodation Required, if admitted? (Y es/No) : ________

(15) Employed (Y es/No) : ________ (If yes, No Objection Certificate from the present employer must be enclosed.)
(16) Correspondence Address (17) Permanent Home Address
________________________________________________ ________________________________________________

________________________________________________ ________________________________________________

District _________________________________________ District ________________________________________

State _________ Pin Code _________________________ State __________ Pin Code ______________________

Email __________________________________________ Email _________________________________________

Tel. /Mobile No. __________________________________ Tel./Mobile No. ________________________________

(Father’ s/Mother’ s/Guardian’ s)

(18) Information for statistical purpose

(a) Religion______________ (b) SC/ST/OBC______________ (c) Rural/Urban_____________________
(d) Father’s/Guardian’s monthly income Rs. ____________________

(19) 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 2011-12 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 initiated against me.

Date: ________________ _____________________________ _____________________________

Thumb impression of the candidate, Male (LTI), Female (RTI) Signature of the candidate

(For the Office of the Proctor)

Nothing objectionable has been found against the candidate. He/she may be considered for admission to _________________
Course for the academic session 2011-12.
_________________________________
PROCTOR
Dated_______________________ With Office Seal

(For Office of the Dean, Students’ Welfare)

Allotted_______________________________ Hall

_________________________________
DEAN, STUDENTS’ WELFARE
Dated_______________________ With Office Seal
 Page 3of 4
(20) List of enclosures attached with the Application Form:

For Office Use 1. DD/Cash Receipt in Original For Office use

1. V erified Original Documents

2. Self attested copy of HS/SSC Certificate or its equivalent
in support of date of birth 2. The candidate is eligible /or not eligible

3. Copies of Marksheets/Grade Sheets of all previous for admission ______________________

Examinations passed/appeared including parts therein
3. Reason(s) for being not eligible________
4. If employed, copy of No Objection Certificate from the
employer _________________________________

_________________________________
5. Copy of documents in support of Special Categories
claimed, if any (________________________________)

6. Copy of Office Memo, if rusticated/debarred/convicted by Signature of V erifying Officer

a court of law
Name ______________________________

7. _____________________________________________ Deptt.______________________________
Signature & Name
of Scrutiny Officer 8. _____________________________________________ Date _______________________________

Note: 1. Original certificates/documents not to be attached with the Application Form in any case.
2. All documents must be self attested.

(21) Candidate is required to write in CAPITAL LETTERS his/her name and complete postal address for correspondence.

Name ____________________________________ Name ____________________________________

Address __________________________________ Address __________________________________

_________________________________________ _________________________________________

District ________________ State _____________ District ________________ State _____________

Pin Code Pin Code

Tel./Mobile No. ____________________________ Tel./Mobile No. ___________________________

Name ____________________________________ Name ____________________________________

Address __________________________________ Address __________________________________

_________________________________________ _________________________________________

District ________________ State _____________ District ________________ State _____________

Pin Code Pin Code

Tel./Mobile No. ____________________________ Tel./Mobile No. ___________________________

 Page 4 of 4
ALIGARH MUSLIM UNIVERSITY, ALIGARH
(2) R. No.: ______________________
For Office Use
Affix
(Do not staple)
INDEX SLIP Non-attested
Photograph
(1) Details of Adm. Test Fee/Process. Charges Session: 2011-12 of size
SSSC (Science Stream)/Diploma in Engg. 2.5cm. x 3 cm.
Photograph must
DD/Cash Receipt No. Dated Amount not exceed this
(Rs.) box.

(3) Name of the Candidate

(4) Father’s Name ____________________________________ (5) Mother’s Name _______________________________________

(6) Correspondence Address ____________________________________________________________________________________

____________________________________________________________________________________

(7) Gender (M/F) ____________________ (8) Tel./Mobile No._________________________________________________

(Father’s/Mother’s/Guardian’s)

_____________________________
Date _______________ Signature of the Candidate

Fold from here Fold from here

ALIGARH MUSLIM UNIVERSITY, ALIGARH For Office use

Scan Slip, 2011-2012

Candidate’s Thumb Impression
Male(LTI), Female(RTI)
Fold from here
Affix
SSSC (Science Stream)/Diploma in Engg.
(Do not staple)
Non-attested
Name ________________________________________ Photograph
of size
Father’s Name _________________________________ 2.5cm. x 3 cm.
Photograph must
Correspondence Address ________________________ not exceed this
box.
_____________________________________________
_____________________________________________
District __________________ State________________
Pin Code
Specimen Signature of the Candidate
Fold from here

ALIGARH MUSLIM UNIVERSITY Postage stamp(s)

Your application for admission to
SSSC (Science Stream)/ Diploma
in Engg. for 2011-2012 has been
received under
________________
of Rs. 6/- must
be affixed here
ACKNOWLEDGEMENT SLIP
INSTRUCTIONS To
(1) Write your complete mailing address on the ______________________________________
right hand side.
R. No.: (2) Keep this card with you as a proof of
submitting your Application Form. ______________________________________
(3) IMPORTANT: For reference always quote
R.No. in all your correspondence/queries. ______________________________________

______________________________________
Dealing Assistant DEPUTY CONTROLLER Pin Code
Date ____________ (Admissions)
 Affix
(Do not staple)
ALIGARH MUSLIM UNIVERSITY, ALIGARH Self Attested
Session: 2011-12 Recent
PROFORMA FOR OUTSTANDING SPORTSPERSON Photograph of
SSSC (Science Stream)/Diploma in Engg. size 2.5cm. x 3 cm.
Instructions:
1. This proforma is to be filled in only if the candidate is desirous of consideration under special category of Sportsperson
2. Candidate is only considered eligible if he/she claims the special category on the main Application Form
3. Candidate must read the Guide to Admissions before filling in this proforma

(1) Tick any one of the following Games/Sports

Athletics Cricket Football Hockey Tennis Swimming
Riding V olley-ball Basketball Badminton Table Tennis Wrestling
Skating Weight Lifting Hiking & Mountaineering
(2) Title of the Event with Highest Award won

(3) Name of the Candidate (Mr ./Ms.)

(As in HS/SS Certificate)

(4) Status (5) Date of birth _____/_____/________

(6) Father’s Name _________________________________ (7) Mother’s Name ______________________________

(8) Correspondence Address

District ____________________________ ____________________ State Pin

(Code only)
(9) Qualifying Year of Passing/ Board/ Marks Maximum
Roll No. Remarks
Examination Appearing University Obtained Marks

(10) Declaration
I hereby solemnly affirm that the facts stated in the proforma are true to the best of my knowledge and belief and no disciplinary action has been taken
against me by any University/College/Sports Authority.
I also undertake that in case I am offered admission under nomination category of “Outstanding Sportsperson/Debater”,
I shall participate in Sports/Debating activities regularly in the University, failing which my admission may be cancelled at any stage and I will have no
claim for my admission in any Court of Law.

Date: Signature of the candidate

(11) Candidate is required to write in CAPITAL LETTERS his/her name and complete postal address for correspondence.

Name ____________________________________ Name ____________________________________

Address __________________________________ Address __________________________________

_________________________________________ _________________________________________

District ________________ State _____________ District ________________ State _____________

Pin Code Pin Code

Tel./Mobile No. ____________________________ Tel./Mobile No. ____________________________

 POSTAL SLIP
Application Form for Admission to
SSSC (Science Stream)/Diploma in Engg.

T o,
DEPUTY CONTROLLER (ADMISSIONS)
ADMISSION SECTION, AMU,
ALIGARH – 202002 (UP)

From:
_____________________________________

_____________________________________

_____________________________________

CANDIDATE’S SLIP
(Keep this slip with you for future reference)

SSSC (Science Stream)/Diploma in Engg. T est Date : 08-05-2011

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. Y ou must ensure that all the documents alongwith Demand Draft/Cash Receipt is attached with the Application
Form.

Note: Demand Draft (valid for 6 months) of the requisite amount should be drawn in favour of FINANCE OFFICER,
AMU, payable at Aligarh.

3. Y ou 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 T est results etc.