1 Total Pages: 3. For Office Use only Examination Roll No . ALIGARH MUSLIM UNIVERSITY, ALIGARH. Course of Main Subject: .. PASTE. (do not staple). recent Subsidiary Subjects: (1).. (2).. PHOTOGRAPH. x 3 cms. Comp.. duly attested by the Provost Regular Ex-Student Cash Receipt No. Dated Rs. Enrolment No. Faculty No. ---------------------------- ---------------------------- 1. Name (in block letters) Mr. / Ms. : .. (As per HS/SSC or equivalent examination). 2. Date of Birth in Christian Era : (In figures).. : (In Words).. 3. Sex : .. 4. Father's Name : .. 5. Mother's Name : .. 6. Religion (In case of Muslims, state : .. Sunni or Shia)/Caste for Non-Muslims Religion (Sunni or Shia) /(SC / ST / BC).
2 7. Permanent Address (in full) : .. : .. : .. 8. Was the candidate ever debarred, disqualified, : Examination .. detained, suspended, rusticated ? If so, give details Roll (attach photocopies of the Office orders) Punishment 9. Is the candidate appearing in Improvement Examination (Yes / No) : .. 10. Is the candidate appearing or has appeared at : Exam.. Roll No.. any other examination of this University or any other examining body this year ? If so, give : Examining details. 11. Details of Examination at which the candidate : Regular / last appeared as Regular/Ex-Student but failed : Exam. Roll *12. Details of Examination Passed: Name of the Year of % of Roll No.
3 Name of University/Board Result Subjects Offered Examination Passing Marks * Candidate is required to enclose self attested photocopy of marksheet. NOTE: 1. This Examination Form is applicable for Regular / Ex-Student, desiring to appear in the examination of the courses, mentioned on the back page of the Hall-Ticket. 2. The students must tick the column of Regular /Ex-Students, whichever is applicable as per Ordinances (Academic). 3. Examination fee is Rs. 200/- in case of Ex-Student . 13. Specify the Papers and their Codes (including Practicals/Seminar/Viva-Voce, etc.) in which the candidate intends to appear in the Examination. CODE NO.
4 TITLE OF PAPERS.. Backlog Papers (if any).. DECLARATION. I hereby solemnly affirm that I have filled this Examination Form myself. If it is discovered at any stage that I have made a false or incorrect statement or concealed the facts or fraudulent means have been used by me for appearing at the examination, I shall be liable to disciplinary action and my examination result may be cancelled. I further affirm that I have not taken Migration Certificate from this University/submitted the Migration Certificate. I shall abide by all the rules and regulations of the University as amended and enforced from time to time.. (Signature of the candidate in full).
5 Room No.. Address for Correspondence (in Block Letters) } Dated: .. Left (Male) Pin : Right (Female). Thumb Contact No.. Impression FOR Office USE ONLY. Certificate to be signed by the Chairman/Coordinator/Director/Principal/ Dean concerned: This is to certify that the student : Certificate to be signed by the Provost (a) is a regular/ex- student of the course of study as detailed in This is to certify that: (a) the candidate is/was a regular member of this Hall during the current session/during the this Examination Form. and his/her Hall dues are clear as on date. (b) fulfils the conditions as laid down in the Ordinances (Academic)/Regulations relating to the course.
6 (c) has chosen the Title of papers and their Codes correctly. (d) has submitted the original marksheet in this Office (in case of appearing for Improvement). Signature (with Seal).. (Provost). Signature (with Seal).. Dated: .. Chairman/Coordinator/Director Signature (with Seal).. Principal / Dean . For Office Use only Examination Roll No .. ALIGARH MUSLIM UNIVERSITY, ALIGARH. Regular / Ex PASTE. (do not staple). recent HALL TICKET PHOTOGRAPH. x 3 cms. duly attested Note: Mention the Code & Title of Papers/Practicals/Seminar, etc. carefully. by the Provost No Corrections / overwriting shall be accepted unless verified by the University authority.
7 Course of Main Subject: .. Regular Ex-Student Name of the Candidate .. (in Block Letters). Faculty No..Enrolment No.. (Papers and their Codes (including Practicals/Seminar/Viva-Voce, etc.). CODE NO. TITLE OF PAPERS.. Backlog Papers (if any).. Permitted to appear in (..) Papers.. (Signature of the Candidate). Left (Male). Right (Female). Dealing Assistant (Examination) Thumb Impression /Assistant Controller Dated (Examinations). Dated.)