AMITY UNIVERSITY ---AMITY SCHOOL OF DISTANCE LEARNING---   ADMISSION-CUM-ENROLLMENT FORM   Admission Details     Form No:   ........................................... Admission Date:  .............................................   Session:  ...................................................................................   Photo Study Centre:  ................................................................................... Student First Name :  ................................................................................... Middle Name :  ................................................................................... Last Name :  ................................................................................... Father's Name:  ................................................................................... Mother's Name:  ................................................................................... Date of birth:  ................................................................................... Nationality:   .................................      City of Domicile:    .............................. Sex:  ................................................................................... Blood Group:  ................................................................................... Identification mark:   ................................................................................... Programme Applied for After Graduation: .................................................................... Programme Code:  ................................................................................... Mode:  ...................................................................................   Add ons:  ................................................................................... Payment Mode:  ................................................................................... E-mail Address:  ...................................................................................   Correspondence Address   Address:   ................................................................................... City:   ................................................................................... Pin Code:   ................................................................................... State:   ................................................................................... Country:   ................................................................................... Phone:   ................................................................................... Mobile:   ...................................................................................   Employment Details, if applicable | Total Number of Years of Experience :  Company Name Address Designation Started From  UpTo  Duration     Educational Qualification Details Qualifying Exam Exam Name School/College/University/Board Subjects Year of passing % of marks 10th 10+2 Graduation Post Graduation Others   FOR OFFICIAL USE ONLY Particulars Verified Document Complete:  __________________   Signature_____________   Office Seal   Name/Designation______________   Fee Receipt Verified Pay Detail :   Application Fee + Course Fee Rs.   ___________ Total Rs.  _______________/- vide DD No.  ________________ Dated   ___________   of   ___________   Bank payable at Delhi/Noida. Date____________________ Place____________________ Signature__________________

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