Total Pages: 4

RX-1

For Office Use only

Examination Roll No.

ALIGARH

MUSLIM

UNIVERSITY,

ALIGARH

Course of Study.............................................................................................
Branch/Main Subject/Specialization (if any): .......................................
Y ear/Part/Semester/Term/Prof...............................Session.....................

RX

For Graduation -Subsidiary (1)............................................... (2).................................

(If applicable)
Comp. (1)......................................... (2)........................................ (3)................................

Regular
Cash Receipt No.

1.

Dated

Ex-Student

Rs.

Name (in block letters) Mr. / Ms.

P ASTE
(do not staple)
recent
PHOTOGRAPH
2.5 x 3 cms.
duly attested
by the Certifying
Authority

Enrolment No.

Faculty No.

----------------------------

----------------------------

............................................................................................................

:
:
:
:
:

(In figures)..........................................................................................
(In Words)..........................................................................................
............................................................................................................
............................................................................................................
............................................................................................................
............................................................................................................

:
:
:

............................................................................................................
............................................................................................................
............................................................................................................

Was the candidate ever debarred, disqualified,

:
detained, suspended, rusticated ? If so, give details
(attach photocopies of the Office orders)

Examination ..................................... Year.........................................

Roll No...................................... Period.............................................
Punishment awarded........................................................................

(As per HS/SSC or equivalent examination)

2.

Date of Birth in Christian Era

3.
4.
5.
6.
7.

8.

Sex
Father's Name
Mother's Name
Religion (In case of Muslims, state
Sunni or Shia)/Caste for Non-Muslims
Permanent Address (in full)

Is the candidate appearing in Improvement

Examination (Yes / No)
10. Is the candidate appearing or has appeared at :
any other examination of this University or any
other examining body this year ? If so, give
details.

Religion

(Sunni or Shia) /(SC / ST / BC)

9.

............................................................................................................
Exam. ........................ Year............... Roll No. ..................................

Examining Body.................................................................................

11. Details of Examination at which the candidate : Regular / Ex-Student.................................................................

last appeared as Regular/Ex-Student but failed : Exam. Roll No.................................Result...............................
*12. Details of Last Examination Passed :
Name of the
Examination

Y ear of
Passing

Roll No.

Name of University/Board

Result

% of
Marks

Subjects Offered

Candidate is required to enclose self attested photocopy of marksheet.

NOTE:

1.
2.
3.

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.
The students must tick the column of Regular /Ex-Students, whichever is applicable as per Ordinances (Academic).
Please see the back page of the Hall-Ticket for details of Examination Fee payable.

[2]
13. Specify the Papers and their Codes (including Practicals/Seminar/Viva-V oce, etc.). in which the candidate intends to appear in
the Examination.
CODE NO.
TITLE OF PAPERS
..
..
..
..
..
..
..
..
..
..
..
..
..
..
Backlog Papers (if any)
..
..
..
..

NOTE: Candidates with Madarsa background studying in M.A. (Arabic/Islamic Studies/ M.Th.) Should also clear English Paper of
SSSC level for award of Degree.
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.

Hall....................................................
Hostel................................................
Room No. .........................................

Address for
Correspondence
(in Block Letters)

(Signature of the candidate in full)

Dated: ...............................................
................................................................
................................................................
Pin :

Left (Male)
Right (Female)

Contact No.

Thumb
Impression

FOR OFFICE USE ONLY

Certificate to be signed by the Provost
This is to certify that:
(a)

Certificate to be signed by the

Dean/Principal/Coordinator/Director concerned:This is to
certify that the student :
(a) is a regular/ex-student of the course of study as detailed in

this Examination Form.

the candidate is/was a regular member of this Hall during the current session/during the
session.................. and his/her Hall dues are clear as on date.
(b) fulfils the conditions as laid down in the Ordinances

Signature (with Seal)....................................................

(Provost)
Dated: ....................

(Academic)/Regulations relating to the course.

(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)....................................................
Dated: .....................(Dean/Principal/Co-coordinator/Director)

For Office Use only

This Page not to be filled in by B.Tech./M. Tech.
students of F/o Engg. & Technology

ALIGARH

MUSLIM

[3]
Examination Roll No.

UNIVERSITY,

ALIGARH

Regular / Ex

P ASTE
(do not staple)
recent
PHOTOGRAPH
2.5 x 3 cms.
duly attested
by the Certifying
Authority

HALL TICKET
Note: Mention the Code & Title of Papers/Practicals/Seminar, etc. carefully.
No Corrections / overwriting shall be accepted unless verified by the University authority.

Course of Study...................................................................................................................................................................................
Branch/Main Subject/Specialization (if any): .............................................................................................................................
Year/Part/Semester/Term/Prof..................................................................................Session.......................................................

Regular

Ex-Student

Name of the Candidate ....................................................................................................Hall............................................

(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)

Dealing Assistant
(Examination)
Dated

Left (Male)

Dated...................................

Right (Female)
Thumb
Impression

S.O. /Assistant Controller

(Examinations)
Dated

[4]
DETAILS OF EXAMINATION FEE
Course
M.A./M.Sc./M.Com./M.P .E./M.F.A./M.S.W./M.A.E.B.M./M.Tech.
(Ag.)/M.B.A./M.B.A.(I.B.) M.F.C./M.T.A./M.Th./M.Ed.
M.C.A./LL.M.
M.L.I.Sc.
M.D. (Unani)/M.S.(Jarahat)
M.D./M.S.(F/o Medicine)
B.A./B.Sc./B.Com.(Hons.)/B.C.A./B.C.M./B.I.T./B.F.A./B.Th./B.Ed.
B.P .Ed./BRTT I Year
B.L.I.Sc.
B.A.LLB./B.E. III/IV Year
B.U.M.S. Pre-Tib.
B.U.M.S. First Professional
B.U.M.S. Second/Third Professional
M.B.B.S./B.D.S. First Professional
M.B.B.S./B.D.S. Second to Final Professional
B. Tech./B.Arch. I, II, III & IV Semester
B. Tech./B.Arch. V , VI, VII, VIII, IX, X Semester
Diploma in Engg. I Y ear
Diploma in Engg. II Year
B.E. I/II year/Diploma in Engg. III Y ear
M. Tech.
Course

Examination Fee
Regular
Ex-Student

Fee per
Backlog Paper

Rs. 60/-

Rs. 70/-

Rs. 50/-

Rs. 100/Rs. 50/Rs. 100/Rs. 400/Rs. 60/Rs. 200/Rs. 50/Rs. 100/Rs. 25/Rs. 35/Rs. 50/Rs. 100/Rs. 150/Rs. 50/Rs. 100/Rs. 30/Rs. 40/Rs. 50/Rs. 150/-

Rs. 110/Rs. 60/-------Rs. 410/Rs. 70/Rs. 210/Rs. 60/Rs. 110/Rs. 35/Rs. 45/Rs. 60/-

Rs. 50/---------------------Rs. 25/--------------Rs. 25/-------------------------------------------------Rs. 25/Rs. 25/Rs. 25/Rs. 25/-

Rs. 160/--------------Rs. 40/Rs. 50/Rs. 60/-

Examination Fee
Regular
Ex-Student
Rs. 15/Rs. 25/-

Cert. / Dip. in Qiraat, Shia Theology

Cert./Dip. of Proficiency in Languages/Certificate in Professional kSills Regular/
Rs. 20/Short Term.
Cert. / Dip. in Linguistics
Rs. 30/Dip. in Teaching/ West Asian Studies/ Ce
rt. in. RS & GIS application in
environment studies/Wild Life Ecology Management/ Dip. /P .G. Dip. in Rs. 50/Professional Courses (1 year)/Dip./Cert. in Professional Courses (2/3 years)
P .G. Dip. in Banking Risk & Insurance Management (BRIM)/P .G. Dip. in Islamic
Rs. 60/Banking and Finance.
P .G. Dip. Translation (Hindi)/ Post M.A. / M.Sc. Dip. /Dip. in Tr
anslation
(Urdu)/P .G. Dip. in Personnel Management/ Marketing Management/ Business Rs. 100/Finance/P .G. Dip. in conflict resolution and Peace Studies / P .G. Dip. in
Hydrology/ Cert./Dip. Course in Urdu Electronic Media.
P .G. Dip. in Languagesof Advertising Media & market/ Biodiversity Management
Conservation/P .G. Dip. in Womens Studies & Mass Communication (Urdu)/ Rs. 200/Advance Dip. in French/ Dip. in Surgical Endoscopic Techniques/Physiotherapy &
Rehabilitation.
P .G. Diploma Courses (F/o Medicine)
Rs. 400/-

Rs. 30/Rs. 40/Rs. 60/Rs. 70/Rs. 110/-

Rs. 210/-

Rs. 410/-

Note: The Examination Form along with the Cash Receipt (in original) of prescribed examination fee and
necessary documents is to be submitted in the office of the Dean / Principal / Coordinator / Director concerned for
onward transmission to Assistant Controller, Examination Division, Controllers Office on or before the notified
last date.