PROF. M. N.

FAROOQUI COMPUTER CENTRE

ALIGARH MUSLIM UNIVERSITY
ICT REQUEST FORM FOR ACADEMIC SESSION: 2022-23
DATED:
D NO: ............ CONTINUATION
.............
Enrollment: GJ1616 Hall of Residence: S. S. Hall (South) Affix
Faculty Number: 20PT051 Hostel: East Wing
Full Name: MOHD FARMAN Room No: 36 (do not st
Date of Birth: AUG 1, 1997 recen
Permanent Address: Vill.Nagla buzurg. Distt. Muzaffarnagar Photogr
Muzaffarnagar-251308 2.5cm x
Father's Name: ABDUL MUNNAF
Uttar Pradesh
India duly atte
Mother's Name: KHURSHIDA by the Pro
Course Type: UG
Course Name: B.U.M.S.
Department: AJMAL KHAN TIBBIYA COLLEGE (FOR BUMS STUDENTS)
UNDERTAKING BY THE APPLICANT
I, Mohd Farman hereby declare that:
I understand that University ICT facilities, meant for Academic/Research support are shared resources, being extended to me for reasonable and bonafide usage only.
I understand that I am solely responsible to protect my Login Credentials and would like to confirm that the same shall neither be revealed to anybody nor it shall be used to supp
unethical/illegal activity.
In case of misuse, my University ICT credentials may be blocked/suspended/withdrawn without any intimation. The university may take disciplinary actions against me as deemed fi
university.
I shall personally ensure to surrender my University ICT Credentials and acquire No-Dues, prior to my leaving the University.
I am aware that University may implement Quota/Ceiling-Flooring Limits, limited timings for availability of service and support of various ICT Services. The same is unconditionally acc
to undersigned.
I am aware that information furnished by me shall be subject to relevant provisions of IT Act 2000 and its subsequent amendments as applicable from time to time.
I am aware that any action or communication, spoken or written or by photo images done using my University ICT Credentials, may be attributed to me, even if it has been done us
University ICT Credentials without my consent or authorization. Consequently, I shall take all relevant precautions needed on my part from time-to-time to protect my Univer
Credentials against misuse.
I shall use my University ICT Credentials as per the policies, procedures and rules maintained by University from time to time.
I have read, understood and accepted all the aforesaid terms and conditions and I am also enclosing my University ID card (valid for minimum 6 months) in support of my requ
University ICT services.
I hereby certify that, the all of my information furnished above is correct to the best of my knowledge and belief & nothing is falsified

____________
Signature of the
IMPORTANT NOTE:
1. It is mandatory on the part of students to send this registration page to Shift-Incharge(on duty) at PROF. M. N. FAROOQUI COMPUTER CENTRE, AMU through University DAK with original signature(s), photograph attestati
endorsement by provost & department concerned.
2. Students should also retain a photo copy of the registration form for their own records.
3. Incorrect, incomplete and applications not received through University DAK shall be considered invalid for processing.
4. It may take upto 5 working days for processing of valid application forms at PMNFCC, after receipt through University DAK only.

CERTIFICATE FROM DEPARTMENT, AJMAL KHAN TIBBIYA COLLEGE (FOR BUMS

CERTIFICATE FROM PROVOST, S. S. HALL (SOUTH)
STUDENTS)
The candidate is/was a regular member of this Hall during the current session (2022-23) and
The entries made above are correct and as per rules, to the best of my knowledge.
his/her Hall dues is clear as on date.
Signature (with seal) _______________
Signature (with seal) _______________
(Dean / Principal / Chairperson / Coordinator / Director)
(Provost)
Dated: _______________
Dated: _______________

gj1616
R NO: _________/CC Dated:_______________ Printed at: Tue Aug 02 21:58:59 IST 2022