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To be filled by candidates qualified in JAM 2010 and desirous of Admission to Academic Programmes of IITs covered
under JAM 2010. This Application should be sent only to “Organizing Chairman, JAM 2010, IIT Madras, Chennai
600 036” and should reach on or before June 7, 2010.
Hearty congratulations for qualifying in the JAM 2010 examination. As a qualified candidate in JAM 2010, you are eligible
to apply for admission to the Master’s programmes provided you satisfy the minimum educational qualification(s) (MEQ)
and eligibility requirement(s) (ER) as outlined in the JAM 2010 brochure. Kindly indicate your order of preferences for the
masters’ programmes you wish to apply in the Choice Sheet in item No 9 given below. Fill all items of this application form
and affix your signature in all pages of this form. Send this form along with relevant enclosures as per item No.11 and a
Demand Draft of Rs. 300/- (Rupees three hundred only) drawn in favour of “JAM 2010” payable at Chennai to the
following address by Speed Post
The Organizing Chairman, JAM 2010, IIT Madras, Chennai 600 036
5(a) Category
(Strike out which ever not applicable) GEN OBC SC ST
Photo of the
candidate
30 x 40 mm
Mobile No.: 0
E-mail: ____________________________________________________________________
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7. Qualifying Examination Result (In the box to the right, write P for PASSED and A for AWAITED)
8. Details of the academic record (attach photo copies of certificate(s) and mark sheet(s)):
10th Standard
12th Standard
(+2 or
equivalent)
* Aggregate of all subjects, including languages and subsidiaries, for all years/ semesters of the programme
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TABLE I
Marks obtained in all papers, including languages and subsidiaries,in
Bachelor’s Degree for all years / semester of the programme*.
Total I = Total II =
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9. Choice Sheet: Academic programmes for JAM 2010
Choose the eligible and interested programmes based on the paper qualified in JAM 2010. If you are
qualified in more than one paper, programmes eligible for both papers are applicable to you. Mention the
order of preference (1,2,3 etc.) in the last column. The programmes that you are 'NOT Interested' mark
'X' in the order of preference column. Please note the order of preference plays an important role in the
admission process. Mention your registration numbers in all the 3 pages of this choice sheet.
Note: If you are qualified in two papers in JAM 2010, and prefer to give choice in the programmes eligible under both the
papers, the order of preference should be a combined one. For example; A candidate is qualified in both BT and CY can
choose order of preference 1 under BT, 2 under CY and 3 under BT and so on.
110 CY M.Sc.-Ph.D. Dual Degree in Environmental Science & Engineering IIT Bombay
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Registration Number in Jam 2010:
Order of
Code JAM Paper Programme Title Institute
Preference
101 GG M.Sc. Applied Geology (4 Semesters) IIT Bombay
Order of
Code JAM Paper Programme Title Institute
Preference
102 GP M.Sc. Applied Geophysics (4 Semesters) IIT Bombay
Order of
Code JAM Paper Programme Title Institute
Preference
106 MA M.Sc. Mathematics (4 Semesters) IIT Bombay
110 MA M.Sc.-Ph.D. Dual Degree in Environmental Science & Engineering IIT Bombay
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Registration Number in Jam 2010:
Order of
Code JAM Paper Programme Title Institute
Preference
103 MS M.Sc. Applied Statistics and Informatics (4 Semesters) IIT Bombay
Order of
Code JAM Paper Programme Title Institute
Preference
107 PH M.Sc. Physics (4 Semesters) IIT Bombay
110 PH M.Sc.-Ph.D. Dual Degree in Environmental Science & Engineering IIT Bombay
Declaration
I hereby declare that the order of preference given by me for my eligible programmes is final.
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10. Details of Demand Draft of Rs. 300/- (Rupees Three Hundred Only) drawn in favour of “JAM 2010”
payable at Chennai.
Amount Date of issue Number Code and Name of the issuing Bank Branch
Rs. 300/-
11. Documents to be enclosed : (Attach a photocopy of each document and tick √ the relevant box(s))
Mark sheets (including title of papers taken) for all semesters/ all the years or up to pre-final
year/semester of the qualifying degree if the result is awaited.
Category Certificate of SC/ST (if applicable), issued by a competent authority (list given in Appendix –
II of the JAM 2010 information Brochure).
Category Certificate of OBC (non-creamy layer) (if applicable), issued by a competent authority in the
format attached (No other format is accepted).
Certificate to support the Person with Disability (PD) status, if applicable, issued by a Government
Medical Board.
Declaration:
I hereby declare that the particulars stated by me in this Application Form for Admission are true to the best of my
knowledge and belief. Moreover, I have verified the information given above and it is found to be correct. I have read the
Information Brochure of JAM 2010 and agree to abide by the terms and conditions therein. It is entirely my responsibility to
prove my eligibility for admission to the program for which I may be admitted and also, in respects of qualification and
entitlement for admission against reserved category, if claimed, to the satisfaction of the Admitting Institute. Further, in the
event of suppression or distortion of any facts such as category, educational qualifications, nationality etc. made in my
original Application Form of JAM 2010 as well as in this Application Form for Admission, I understand that my admission,
if granted, and/or degree/ diploma acquired subsequently are liable to be cancelled/ withdrawn. I also understand that the
decision of the Organizing Institute and the Admitting Institute regarding my admission will be final and I shall abide by the
ordinances and regulations of the Admitting Institute in vogue from time to time. I further understand that the Order of
Preferences for program(s) and corresponding Institute(s) given by me in this form are final and no alteration will be
permissible under any circumstances.
Place:
Date:
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INDIAN INSTITUTES OF TECHNOLOGY
(Bombay, Delhi, Guwahati, Hyderabad, Kanpur, Kharagpur, Madras, Roorkee)
UNDERTAKING
To be given by a candidate whose qualifying examination result is awaited and hence is provisionally admitted
1. Name :
3. Test Paper(s) :
I understand that my admission to any of the IITs is provisional since I have not submitted the attested
copies of the qualifying examination certificate and/or mark sheet as per the eligibility criteria stated in
Sections 4 and 5 of the Information Brochure for JAM 2010.
I also understand that in the event of my failing to fulfil the eligibility criteria on or before
September 30, 2010, my provisional admission to any of the IITs will stand cancelled.
_____________________
Signature of the candidate
Place : _____________________
____________________________
Countersigned by Parent/ Guardian
Date : ______________________
PHYSICAL FITNESS CERTIFICATE
(To be issued by a Medical Officer in a Government Hospital)
GENERAL EXPECTATIONS
Candidates should have good general physique. In particular,
a) Chest Measurement should not be less than 70 cm, with satisfactory limits of expansion and contraction.
b) Vision should be normal. In case of defective vision, it should be corrected to 6/9 in both eyes or 6/6 in the
better eye.
c) Hearing should be normal. Defective hearing should be corrected.
d) Heart and lungs should not have any abnormality and there should be no history of mental illness or
epileptic fits.
PERSONAL HISTORY
1. Name …………………………………………………………………………………….………
2. Registration Number in JAM 2010 ...………………………………………………..…………
3. Parent/ Guardian’s Name……………………………………………………………….........….
4. Date of birth: …………………Age (As on 01-06-2010) : Years …...….. Months……......…..
5. Gender……………………….
6. Identification Mark on the Body, if any
…………..………………………………………….……………………………………………
(This can be a mole, scar or birthmark)
CERTIFICATE
(The following are to be filled by the Medical Officer conducting the medical examination)
b) Hydrocele ……………………
Certified that……………...………..……………………………………………………………………
a) fulfils the prescribed standard of physical fitness and is FIT for admission to IITs.
b) does not fulfil the prescribed standard of physical fitness and is unfit/ temporarily unfit for
admission due to following defects.
Date..………………………………….
Full Name.………………………........
Medical/Registration No……………..
Official Seal
JAM 2010
Organizing Institute, IIT Madras
(Bombay, Delhi, Guwahati, Hyderabad, Kanpur, Kharagpur, Madras, Roorkee)
DECLARATION FORM
Candidates who have been offered the academic programme of their first preference do not have
to send this form.
I hereby declare that I have read the Information Brochure of JAM 2010 and I am fully
aware of consequences of the choice filled by me in item 4 above. As a consequence of the
choice filled by me, if I am offered admission against any of my higher preference
programmes, I shall accept the newly offered programme and I am fully aware that the seat
presently offered will be automatically treated as vacant for its allotment to another eligible
candidate. I also understand that once I am offered a seat in the higher preference
programme I shall have no claim to the seat presently offered to me even if I do not join the
higher preference programme, for whatsoever reasons.
Date :
a) He / she has appeared for the final examination held during ……….………. 2010, the results of
which are awaited.
Date :
University :
___________________________________________________________________________________________________
NB: Those who are appearing for qualifying examination after 15th July 2010 are not eligible for admission even if
offer of provisional admission is issued.
Proforma for Other Backward Class (OBC) Certificate
(i) Resolution No. 12011/68/93-BCC(C) dated 10/09/93 published in the Gazette of India Extraordinary Part I Section I No.
186 dated 13/09/93.
(ii) Resolution No. 12011/9/94-BCC dated 19/10/94 published in the Gazette of India Extraordinary Part I Section I No. 163
dated 20/10/94.
(iii) Resolution No. 12011/7/95-BCC dated 24/05/95 published in the Gazette of India Extraordinary Part I Section I No. 88
dated 25/05/95.
(iv) Resolution No. 12011/96/94-BCC dated 9/03/96.
(v) Resolution No. 12011/44/96-BCC dated 6/12/96 published in the Gazette of India Extraordinary Part I Section I No. 210
dated 11/12/96.
(vi) Resolution No. 12011/13/97-BCC dated 03/12/97.
(vii) Resolution No. 12011/99/94-BCC dated 11/12/97.
(viii) Resolution No. 12011/68/98-BCC dated 27/10/99.
(ix) Resolution No. 12011/88/98-BCC dated 6/12/99 published in the Gazette of India Extraordinary Part I Section I No. 270
dated 06/12/99.
(x) Resolution No. 12011/36/99-BCC dated 04/04/2000 published in the Gazette of India Extraordinary Part I Section I No. 71
dated 04/04/2000.
(xi) Resolution No. 12011/44/99-BCC dated 21/09/2000 published in the Gazette of India Extraordinary Part I Section I No. 210
dated 21/09/2000.
(xii) Resolution No. 12015/9/2000-BCC dated 06/09/2001.
(xiii) Resolution No. 12011/1/2001-BCC dated 19/06/2003.
(xiv) Resolution No. 12011/4/2002-BCC dated 13/01/2004.
(xv) Resolution No. 12011/9/2004-BCC dated 16/01/2006 published in the Gazette of India Extraordinary Part I Section I No.
210 dated 16/01/2006.
This certificate is being issued based on the annual income / status of the parents / guardian of the applicant as on
financial year ending March 31, 2009.
Dated:
District Magistrate/
Seal : Deputy Commissioner, etc.
NOTE:
(a) The term ‘Ordinarily’ used here will have the same meaning as in Section 20 of the Representation of the People Act,
1950.
(b) The authorities competent to issue Caste Certificates are indicated below:
(i) District Magistrate / Additional Magistrate / Collector / Deputy Commissioner / Additional Deputy
Commissioner / Deputy Collector / Ist Class Stipendiary Magistrate / Sub-Divisional Magistrate / Taluka
Magistrate / Executive Magistrate / Extra Assistant Commissioner (not below the rank of 1st Class Stipendiary
Magistrate).
(ii) Chief Presidency Magistrate / Additional Chief Presidency Magistrate / Presidency Magistrate.
(iii) Revenue Officer not below the rank of Tehsildar and
(iv) Sub-Divisional Officer of the area where the candidate and / or his/her family resides.
FORMAT OF CERTIFICATES
Certificate for SC/ST Candidates : To be issued by District Magistrate/Additional District Magistrate/Collector/Deputy
Commissioner/Additional Deputy Commissioner /Deputy Collector/1st Class Stipendiary Magistrate/City Magistrate/Sub-
Divisional Magistrate/Taluk Magistrate/Executive-Magistrate/Extra Assistant Commissioner/ Chief Presidency
Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate/Revenue Officer not below the rank of
Thasildar/Sub-Divisinal Officer of the area where the candidate and/or his family normally resides/Administrator/ Secretary
to Administrator/Development Officer (Lakshadweep Islands).
Tribe.
Alternative Certificate
Applicable only to SC/ST persons who have migrated from one state to another for purpose of employment, education, etc.
This certificate is issued on the basis of the Scheduled Caste/Scheduled Tribe Certificate issued to
issued by the …………….…………………… (name of issuing authority) vide their No………………………..……….. and
dated ……..……………...