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Application for P.G. Diploma (Distance Mode) (2021-22)

REGISTRATION NO:
JMI944497PGDGC PAYMENT ID:
JMIDOE61a5cd237429c465

AAdhar No: 969488947228

Course Name:
Post Graduate Diploma in Guidance & Counselling
‫ کورس کا نام‬/ पाठयक्रम का नाम :

Candidate Name:
TARUN KUMAR
‫ درخواست گزار کا نام‬/आवेदक का नाम :
Father's Name:
Shri Niwas
‫ والد کا نام‬/ पिता का नाम :
Mother's Name:
Rita Devi
माता का नाम:
Father's / Mother's / Spouse (if 9953252184
married) Mobile Number:

‫ والدہ کا موبائل نمبر@والد‬/पिता / माता

का मोबाइल नंबर :
Date of Birth:
05 January, 1998
‫ تاریخ پیدائش‬/ जन्म तिथि :

Sex/‫ جنس‬/लिंग: Male Social Category/‫کالس‬/वर्ग: GENERAL

Blood Group:
AB+
‫ بلڈ گروپ‬/ ब्लड ग्रुप :
Nationality/‫قومیت‬//राष्ट्रीयता : Indian
Religion/‫مذہب‬/धर्म: HINDU

Address For Correspondence  पत्राचार का पता Permanent Address  स्थायी पता

Name:
TARUN KUMAR Guardian's Name (If Shri niwas
‫ درخواست گزار کا نام‬/ आवेदक Applicable)

का नाम

Address / ‫ پتہ‬/पता : H.no 49 thola wala rana pana Address / ‫ پتہ‬/पता : H.no 49 thola wala rana pana

  Near balti wala kua   Near balti wala kua

   

District / ‫ ضلع‬/जिला: North west delhi District / ‫ ضلع‬/जिला: North west delhi

State / ‫ ریاست‬/ राज्य: Delhi State / ‫ ریاست‬/ राज्य: Delhi

Pin / ‫ ِپ ن‬/ पिन: 110039 Pin / ‫ ِپ ن‬/ पिन: 110039

Ph. No. with STD Code Ph. No. with STD Code

Mobile No./‫موبائل نمبر‬/ (+91) 7011230736 Fax No.

मोबाइल नंबर:
Mobile No./‫موبائل نمبر‬/ (+91) 7011230736
Email tarunrana5757@gmail.com मोबाइल नंबर:

Annual Income of your Parents/Guardians in Rs. Between 1 to 2 lacs

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Name(HTTPS://JMI.UCANAPPLY.COM/UNIVER/PUBLIC/USER-LOGOUT?APP_ID=UELZMDAWMDA0NG==)
of the Examination Board / University Year of Passing / School Name/College Max Marks Marks Marks CGPA
Appearing Obtd. %

(10+2)th std. Central Board of Secondary Education, Delhi 2016 kv afs bawana 500 365 73

Bachelor Degree delhi university 2021 shardhanand college alipure delhi 1200 642 53.5

Support Centre Preference

Preference - 1 (JSC-DL-01) Center for Distance and open Learning Jamia Millia Islamia Jamia Nagar NEW Delhi

Uploaded Documents:
1. Original Marksheet of Graduation

Signature Uploaded by the

candidate/ ‫بذریعہ امیدوار‬
‫ َا پلوڈیڈ دستخط‬/ अभ्यर्थी द्वारा
अपलोडेड हस्ताक्षर

It is hereby confirmed that I have carefully read the concerned Information Bulletin available on the JMI's Entrance Test Portal (www.jmionline.in) before filling up the Application Form.

I hereby solemnly affirm that the information furnished in this Online Application Form is true and correct to the best of my lnowledge and belief and no material information has been
concealed or suppressed. If any information is found to be false, incorrect or misleading, the Jamia Millia Islamia shall have the authority to cancel my candidature / admission without any
further enquiry or notice.

I undertake that, if admitted, I shall abide by the UGC Regulations on Curbing the Menace of Ragging, 2009, Ordinances governing the discipline of students of Jamia Millia Islamia and such
other Rules, Ordinances and Regulations that may be framed by the Jamia Millia Islamia/ UGC from time to time.

I further undertake that the preference for the Test center, Courses, Domicile and the categories to which I belong as indicated by me in the online application form shall be irrevocable.

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