Date: Aug 06, 2019 Application Ref. No.

: JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/3565

Jamia Boys' Hostel

Application Form for Jamia Boys Hostel New Admission (2019-20)

Personal Information

Registration No/ Enrollment No JMI0368521

Name of the Student FAHIM ALI
Category GENERAL
Father's Name ARMAN ALI SIDDIQUI
Mobile No of Father 9162620997
Date of Birth 27/06/2000
E-mail id of Father ALIFAISAL909@GMAIL.COM
Mother's Name SIKANDRI KHATOON
Mother's Mobile Number 9504774357
Guardian's Name FAISAL ALI
Guardian's Mobile Number 8010749796
Student Id
Course B.SC.-AERONAUTICS, (MECHANICAL/AVIONICS) - B39
Year/Semester I-SEMESTER
Faculty FACULTY OF ENGINEERING & TECHNOLOGY
Department/ Centre FACULTY OF ENGINEERING & TECHNOLOGY
Distance from Hometown 960
Family Annual Income 200000
NCC -
Sports -
Seniority in University (years) 10
Are you differently abled (40%
-
disability)
E-mail ID of Applicant FAHIM78400@GMAIL.COM

Permanent Address

VILL NIRANJANA , POST AND PANCHAYAT - BARAIPATTI , PS - YADAWPUR , DIST -

Permanent Address
GOPALGANJ , BIHAR
Street VILLAGE NIRANJANA Post/Town BARAIPATTI
Country INDIA State BIHAR
City/District GOPALGANJ PIN Code/ ZIP Code 841428

Academic Record

Passed/ Marks Total Percentage

Examination Board/University Subjects Year CGPA
Awaited Obtained Marks Equivalent
HINDI,
CENTRAL ENGLISH,
BOARD OF MATHS,
X CBSE PASSED 2015 418 500 8.8 83.60
SECONDARY SCIENCE,
EDU SOCIAL
SCIENCE

Application for Jamia Boys Hostel New Admission (2019-20) 1/4 Application Ref. No. : JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/3565
 HINDI ,
BIHAR
ENGLISH,
SCHOOL
XII BSEB PHYSICS , PASSED 2018 322 500 6.7 64.40
EXAMINATIO N
CHEMISTRY ,
BOARD
MATHEMATIC S

Percentage of Marks in Qualifying Examination* 64.40 Result Awaited -

Application for Jamia Boys Hostel New Admission (2019-20) 2/4 Application Ref. No. : JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/3565
Particulars of Local Guardians

Particulars of Local Guardian

Name FAISAL ALI
Relation with the Applicant BROTHER
H NO F 140, SHAHEEN BAGH , ABUL FAZAL ENCLAVE 2, JAMIA NAGAR OKHLA ,
Address
NEW DELHI ,110025
Mobile No 8010749796
E-mail ID ALIFAISAL9 09@GMAIL.C OM

Application for Jamia Boys Hostel New Admission (2019-20) 3/4 Application Ref. No. : JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/3565
List of Documents to be brought at the time of Interview :
1. A Demand Draft of Rs 200/- drawn in favour of The Registrar, Jamia Millia Islamia to be deposited alongwith the Application Form
in the Provost Office at the time of Interview. 2. Fee Receipt of Admission to the Course in Jamia Millia Islamia. 3. Self Attested Mark
sheet of qualifying Examination. 4. Certificate of Sports (State/National Level) and NCC (A,B,C Certificate), if applicable. 5. Self
Attested copy of Voter ID/Aadhar/Passport. 6. Documents supporting Economically Weaker Section, if applicable. 7. Documents
supporting Physical Disability (40%) for Persons with Disabilities (PWD) category, if applicable. 8. Three passport size photos of
applicant. 9. Photographs, ID proof, Address proof of parents and both the Local Guardians. 10. Undertaking by the Applicant to
follow University/ Hostel Code of Conduct**. 11. Financial guarantee and declaration by the applicant’s parent/guardian**. 12.
Affidavit by both the Local Guardians** 13. Declaration by the applicant**

Note
*Guardian is a person in whose guardianship the applicant has been brought up in absence of both the natural parents due to demise
or otherwise.

*Kindly bring a copy of this form along with the documents mentioned above when called for interview. The Applicant must appear for
the interview with both the local guardians mentioned in her form.

*If the form is incomplete in any respect or if the candidate fails to provide any of the documents mentioned above, she will not be
allowed to appear for interview before the Interview Committee.

**click here to download Affidavit and supporting documents.https://www.jmi.ac.in/upload/hostel/hgr_affidavit.pdf

(Signature of the Applicant)

Date: August 06, 2019 Place:

Application for Jamia Boys Hostel New Admission (2019-20) 4/4 Application Ref. No. : JMI-BOYS-HOSTEL-ADMISSION/2019-20/I/3565