NIMS UNIVERSITY

Fully empowered & incorporated as a regular & full-fledged University under NIMS UNIVERSITY ACT, 2008 duly recognized by Government of India under the provisions of the Sections 2(f) and 22 of the UGC Act, 1956.
FACULTIES: Medicine Dentistry Engineering Advanced Engg. Management Law Pharmacy Nursing Science & Technology Physiotherapy Allied Health Sciences Fashion Media Mass Comm. Hospitality Aviation Education Library Sciences Physical Education Films & Television etc. multi-specialty 1000-bedded tertiary level Hospital on campus

NIMS UNIVERSITY:

AN

ISO 9001 : 2008 CERTIFIED ORGANIZATION

Paste Recent Photograph (Do not Staple or Pin)

APPLICATION FORM FOR ADMISSION ACADEMIC YEAR 2011-12

Name of Course: Specialization (if any):
1.

.. ..

To be filled in CAPITAL letters only Candidates Name (As given in Class 10th Certificate):

2. 4.

Date of Birth: D D M M Y Y Y Y Marital Status: GEN Single / Married SC ST OBC

3. 5. Nationality:

Gender:

6. Category: 7.

OTHERS

(a) Fathers / Guardians / Husbands Name:

(b) Mothers Name:

8. 10.

Fathers/ Guardians/ Husbands Occupation: Permanent Address:

9.

Annual Family Income (Rs.)

STD Code E-mail ID 11.

Landline No.

Mobile No.

Correspondence Address (if different from above):

Campus Address:

NIMS UNIVERSITY

Shobha Nagar, Delhi Highway Jaipur-303121 (Rajasthan)

Phone: (01426)-513102, 513103 Fax: (0141)-2605050, (01426)-231909 Mobile: 09799418000, 9799437000, 9829051020 Email:info@nimsuniversity.org Web: www.nimsuniversity.org

NIMS UNIVERSITY
Full empowered & incorporated as a regular & full-fledged University under NIMS UNIVERSITY ACT, 2008 duly recognized by Government of India under the provisions of the Sections 2(f) & 22 of the UGC Act, 1956.

NIMS UNIVERSITY:

AN

ISO 9001 : 2008 CERTIFIED ORGANIZATION

STD Code E-mail ID

Landline No.

Mobile No.

Continuation Sheet

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NIMS UNIVERSITY
Full empowered & incorporated as a regular & full-fledged University under NIMS UNIVERSITY ACT, 2008 duly recognized by Government of India under the provisions of the Sections 2(f) & 22 of the UGC Act, 1956.

NIMS UNIVERSITY:

AN

ISO 9001 : 2008 CERTIFIED ORGANIZATION

12.

Educational Qualification (Start from the highest qualification first):

Name of Board / University Year of Passing Name of School / College / Institution Overall Marks (% of Grade Major Subjects

Title of Degree / Qualification

DECLARATION BY THE APPLICANT

1. I hereby declare that al particular stated in this application are true to the best of my knowledge and belief. I have read and understood all the provision of the prospectus and agree to abide by them in the event of suppression or distortion, if any facts like educational qualification, nationality, study period etc. made in this application form I understand that my admission / registration is liable to be cancelled at any stage. I am fully convinced with all the information given in the information and understood all the rules and regulation. 2. That, if admitted to NIMS UNIVERSITY, I shall abide by its rules and regulation 3. That, I am aware that for getting admission/ Registration in NIMS UNIVERSITY, fee (Full/Part) and any charges (Full/Part), which I have deposited to the university shall not be refunded on any pre-text. 4. That, I know that after the admission formalities are completed, If I want cancellation of my admission due to one or other reason, or if I discontinues my study or request for cancellation of my admission from the course, even though, I have not attended any class, fee/any other charges paid by me will not be refunded to me or any pre-text. 5. In the event of known commitment / non-compliance of this declaration form, university can take any action 6. Jurisdiction of any dispute shall be Jaipur City, Jaipur only. Place:__________________ Date: __________________

Signature of Applicant

Signature of Parent/Guardian

Continuation Sheet

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NIMS UNIVERSITY
Full empowered & incorporated as a regular & full-fledged University under NIMS UNIVERSITY ACT, 2008 duly recognized by Government of India under the provisions of the Sections 2(f) & 22 of the UGC Act, 1956.

NIMS UNIVERSITY:

AN

ISO 9001 : 2008 CERTIFIED ORGANIZATION

FOR OFFICE USE ONLY Receipt No. Date Name of the Accountant .. Signature of the Applicant Name: .. Date: .

Signature of Parent / Guardian Name: .. Date: .

Academic Documents Required (Attach true copies duly attested by a Gazetted Officer with name, signature and stamp): o Degree/ Mark-sheets of qualifying examination o Migration/ Transfer Certificate from the last School / College / Institution o Certificate & Mark-sheet of standard 10+2
o

Certificate & Mark-sheet of 10th standard

o Degree / Mark-sheets / Certificates of all qualifications o Certificate for break / gap in education, if any Other Documents (Attach true copies self attested by the Applicant & counter signed by Parent/ Guardian): o Address Proof (any one of Ration Card, Driving License, Voter ID Card, Passport) o Identity Proof (any one of Ration Card, Driving License, Voter ID Card, Passport, PAN Card) o Caste Certificate (if the Applicant belongs to any category other than General)

Continuation Sheet

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