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For Office Use only

Transaction ID: 8345699/MBAM

ALIGARH MUSLIM UNIVERSITY


Session: 2011-12
Application Form for Admission to
M.B.A./ M.B.A.(IB)/ PG DIP. I.B.F.
FACULTY OF MGMT. STUDIES & RESEARCH

Bank: STATE BANK OF INDIA, DD/CR No.: 231211, Date: 2011-03-15, Amount: 300

Affix the same


Photograph as you
have uploaded in
the Application Form

Nationality: INDIAN

Order of Preference of Branches:


__________________________________________________________________________________________________
1. MBAA 2. MBAW 3. MBAK 4. MBIB 5. PDIB 6. -- 7. -- 8. -- 9. -Preference for Test Centres:
__________________________________________________________________________________________________
1. Kolkata 2. Aligarh

Personal Details:
__________________________________________________________________________________________________
Name: TABREZ MALLICK
Date of Birth: 20-09-1989
Gender: MALE
Religion: ISLAM

Father's Name: ZUBAIR MALLICK


Mother's Name: SHAHJAHAN BEGUM
Parent's/Guardian's Monthly Income: 15000
Rural/Urban: URBAN

Details of Qualifying Examination:


Status & Special Categories:
__________________________________________________________________________________________________
Examination: B.COM HONS 3
Roll No.: 08BC8163899
Year of Passing/Appearing: 2011
Board/Univ.: RUR
Marks Obt./Max. Marks: /
Remarks (if any): RA

Status: EXTERNAL
Enrolment No.:
Hall:
Special Categories: 1. -- 2. -- 3. --

Course(s) Studied/Studying other than Qualifying Examination (Starting from the latest):
__________________________________________________________________________________________________
Course

Yr. of Passing/Appearing

B.COM HONS PART 2


B.COM HONS PART 1
INTERMEDIATE
SECONDARY

2010
2009
2007
2005

Board/Univ.

RUR
RUR
JHB
JHB

Roll No.

O8BC8163989
O8BC8163989
20280
0039

Permanent Address:
Address for Correspondence:
__________________________________________________________________________________________________
Address: ROAD NO-6 H NO-14 AZADNAGAR
MANGO JAMSHEDPUR
EAST SINGHBHUM - 832110(JH)

Address: ROAD NO-6 H NO-14 AZADNAGAR


MANGO JAMSHEDPUR
EAST SINGHBHUM - 832110(JH)

Phone 1: 08092534364

Email ID: tabrez.mallick@yahoo.com

Phone 2: 08092534364

If admitted, is hostel accomodation required? YES


__________________________________________________________________________________________________
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 may be initiated against me.
Transaction ID: 8345699/MBAM

Thumb Impression
Male: Left Thumb, Female: Right Thumb

__________________________
Signature of the Candidate

FOR OFFICE USE ONLY

List of enclosures attached with the Application Form:

1.

DD/Cash Receipt in Original

2.

Self Attested copy of HS/SS Certificate in support of date of Birth

3.

Copies of Marksheets/Grade Sheets of all previous Examinations


passed/appeared including parts therein after passing High School

4.

If employed, copy of No Objection Certificate from the employer

5.

Copy of documents in support of Special Categories clamied, if any

6.

Copy of document(s), if rusticated/debarred or convicted by a court of law

____________________________________

7.

________________________________________

Remarks ____________________________

8.

________________________________________

Signature of Scrutiny Officer


Identity & Original Documents Verified
The candidate is eligible/not eligible for admission to

Verifying Officer ____________________

Hall Allotted:

Dept. of ___________________________
Date ____________________
Clearance by Proctor

DSW

Address Slips (for Office Use):

--------------------------------------------------------------------------------------------------------------------------------------Name: TABREZ MALLICK


Name: TABREZ MALLICK
Address: ROAD NO-6 H NO-14 AZADNAGAR
Address: ROAD NO-6 H NO-14 AZADNAGAR
MANGO JAMSHEDPUR
MANGO JAMSHEDPUR
EAST SINGHBHUM - 832110(JH)
EAST SINGHBHUM - 832110(JH)
Tel./Mobile: 08092534364
Tel./Mobile: 08092534364
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name: TABREZ MALLICK
Name: TABREZ MALLICK
Address: ROAD NO-6 H NO-14 AZADNAGAR
Address: ROAD NO-6 H NO-14 AZADNAGAR
MANGO JAMSHEDPUR
MANGO JAMSHEDPUR
EAST SINGHBHUM - 832110(JH)
EAST SINGHBHUM - 832110(JH)
Tel./Mobile: 08092534364
Tel./Mobile: 08092534364
---------------------------------------------------------------------------------------------------------------------------------------

Transaction ID: 8345699/MBAM

Aligarh Muslim University


Scan Card, 2011-12
M.B.A./ M.B.A.(IB)/ PG DIP. I.B.F.

(For Office Use only)

Affix the same

Name: TABREZ MALLICK


Address:
ROAD NO-6 H NO-14 AZADNAGAR
MANGO JAMSHEDPUR
EAST SINGHBHUM - 832110(JH)
Tel./Mobile: 08092534364

Photograph as you
have uploaded in
the Application Form

Thumb Impression
Male(Left Thumb)/Female(Right Thumb)
Specimen Signature of the candidate

ACKNOWLEDGEMENT SLIP, AMU, Aligarh


Application form for admission to:
M.B.A./ M.B.A.(IB)/ PG DIP. I.B.F., 2011-12
has been received.
R. No. is: _______________________
Transaction ID: 8345699/MBAM

To,
Name: TABREZ MALLICK
Address: ROAD NO-6 H NO-14 AZADNAGAR
MANGO JAMSHEDPUR
EAST SINGHBHUM - 832110(JH)
Tel./Mobile: 08092534364

Rs. 6/Postage Stamps

POSTAL SLIP
Application Form for Admission to
M.B.A./ M.B.A.(IB)/ PG DIP. I.B.F.

To,
DEPUTY CONTROLLER (ADMISSIONS)
ADMISSION SECTION, AMU,
ALIGARH - 202002 (UP)
From:
Name: TABREZ MALLICK
Address: ROAD NO-6 H NO-14 AZADNAGAR
MANGO JAMSHEDPUR
EAST SINGHBHUM - 832110(JH)
Tel./Mobile: 08092534364

--------------------------------------------------------------------------------------------------Aligarh Muslim University


CANDIDATE'S SLIP

(Keep this Slip with you for future reference)


Course Applied for: M.B.A./ M.B.A.(IB)/ PG DIP. I.B.F.
Transaction ID: 8345699/MBAM
Test Date: 24.4.2011
Password: 1989-09-20
_______________________________________________________________________________

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. You must Ensure that all the documents along with 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 favor of FINANCE OFFICER, AMU, payable at
Aligarh.

3. You 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 Test results etc.

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