To be filled in by the Office

Hindi/English Medium
Admission No.

APPLICATION FORM
Urdu Correspondence Course Affix your recent
Arjun Singh Centre for Distance and Open Learning Photograph
Jamia Millia Islamia
Jamia Nagar, New Delhi-110025

Candidates full name:

Fathers name:

Mothers name:

Category: General Scheduled Caste Scheduled Tribe Physically Handicapped

Nationality Mother Tongue Aadhar No. ..........

Date of Birth: Date: Month: Year: Age:

Address: (i) Permanent Address:

PIN .

(ii) Mailing Address

.
PIN .

Telephone No..Email...
Present Occupation: ..
Date. Signature
(FOR OFFICE USE ONLY)
Received I.P.O./ Bank Draft No. ..Dated.For Rs.
As prescribed fee.
Dealing Assistant
Admitted and allotted
No ..

Admit and send teaching material Signature

Head

Please send a Postal Order or a Bank Draft of Rs. 100/- (Rs. Hundred only) for Indian National, US $ 20 ( US Dollars Twenty only ) for Foreigners (SAARC
countries) and US $ 50 (US Dollars Fifty only) other Countries addressed to JAMIA MILLIA ISLAMIA, payable at NEW DELHI along with this admission form
For detail please contact at: ucc@jmi.ac.in Tel: 26981717 / 2845