Important (1) Course Applied For(2) Department (3) Faculty(4) Order of Preference of Main Subjects/ Specialization/Course alongwith its Code(s)i) _______________________ iii) _______________________ii) _______________________ iv) _______________________(5) Status (5a) Enrolment No. (5b) Hall/NRSC(6) Name of the Candidate(7) Fathers Name ___________________________________ (8) Mothers Name ______________________________(9) Date of Birth(12)(i) Special Category Claimed (iii) Domicile State(ii) Order of preference of Courses/Main Subjects along its course code in which the candidate wishes to be nominated(a) _____________________________ (b) _____________________________(13) Details of Qualifying ExaminationExamination Roll No.Year ofPassing/AppearingBoard/University Marks MaximumMarksRemarks(Write RA ifresult notdeclared)Marks Obt./MaxCourse Name DD/C.R. No.with dateAmount(Rs.)Affix(Do not staple)Self AttestedRecentPhotograph ofsize 2.5cm. x 3 cm.(For Office use only)Page 1of 4(Internal/External) (For candidates already enrolled or has been a student of AMU, Aligarh) (Code only)Subject(Code only)(As in HS/SS Certificate)Day Month Year(11) Gender (M/F)(To be filled up by the candidate belonging to special categories, who in the event of not being selected, wish to be considered for nomination)(Attach Attested Certificate) i) ii) iii)Claim for Nomination(10) Applicable to M.Tech. Courses only(Mr./Ms.)Regular Part-time(a) Gate Score / Passing yearMode Mode(b) Tick the appropriate option given below