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    Name of Bank: Branch: Draft/Cheque/Cash Receipt No: Dated: Amount: Bank

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    Mohd Luqman Chaudhary
    This document contains an alumni membership form requesting personal details such as name, program studied, enrollment number, date of birth, nationality, occupation, contact information, permanent address, and subscription details. It provides the option of annual or life membership and requires a declaration that the applicant agrees to abide by the constitution and was not previously expelled or found guilty of offenses. Upon completion, the form is to be submitted to the GJAN office along with photographs and payment for processing and issuance of an alumni membership card.

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    Name of Bank: Branch: Draft/Cheque/Cash Receipt No: Dated: Amount: Bank

    Uploaded by

    Mohd Luqman Chaudhary
    27 views2 pages
    This document contains an alumni membership form requesting personal details such as name, program studied, enrollment number, date of birth, nationality, occupation, contact information, permanent address, and subscription details. It provides the option of annual or life membership and requires a declaration that the applicant agrees to abide by the constitution and was not previously expelled or found guilty of offenses. Upon completion, the form is to be submitted to the GJAN office along with photographs and payment for processing and issuance of an alumni membership card.

    Original Title

    gjan_form.pdf

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    This document contains an alumni membership form requesting personal details such as name, program studied, enrollment number, date of birth, nationality, occupation, contact information, permanent address, and subscription details. It provides the option of annual or life membership and requires a declaration that the applicant agrees to abide by the constitution and was not previously expelled or found guilty of offenses. Upon completion, the form is to be submitted to the GJAN office along with photographs and payment for processing and issuance of an alumni membership card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    27 views2 pages

    Name of Bank: Branch: Draft/Cheque/Cash Receipt No: Dated: Amount: Bank

    Uploaded by

    Mohd Luqman Chaudhary
    This document contains an alumni membership form requesting personal details such as name, program studied, enrollment number, date of birth, nationality, occupation, contact information, permanent address, and subscription details. It provides the option of annual or life membership and requires a declaration that the applicant agrees to abide by the constitution and was not previously expelled or found guilty of offenses. Upon completion, the form is to be submitted to the GJAN office along with photographs and payment for processing and issuance of an alumni membership card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    1.

    Name: Dr/Ms/Mrs/Mr ;
    2. Program/Course studied:
    3. Enrolment No*:
    4. Year:
    5. Date of Birth*:
    6. Nationality :
    7. Present/last held occupation *:

    8. Mobile No*:
    9. E-mail:
    10. Permanent Address*:

    11. Subscription: Annual membership Life membership

    Life membership Rs. 5,000/- OR US$ 100 (ii) Annual membership Rs. 1000/- OR US$ 25

    (i) Demand Draft/Cheque (In favour of The Registrar, Jamia Millia Islamia, payable at New
    Delhi, India)

    Name of Bank: Branch:


    Draft/Cheque/Cash Receipt No: Dated:
    Amount: Bank:

    Alumni Membership Card

    To get the Alumni Membership Card, two identical Passport size photographs with Name and
    Enrolment number clearly written on the back be submitted along with the form to the office of
    GJAN.

    Declaration
    I, hereby declare that:
    The particulars given above are correct information.
    I have read the constitution of the G- JAN and agree to abide by it.
    I was never expelled from the University
    I was never debarred from seeking admission to any Department of
    University.
    I was not found guilty of any offence involving moral turpitude or gross
    misbehavior; including resorting to unfair means in examination.

    Place: Signature:

    Date:

    TO BE FILLED IN BY THE OFFICE


    1. Nature of Membership …………………………………………………………………

    2. Membership number ………………………………………………………………….

    3. Date of Registration ………………………………………………………………….

    Signature of Chairman

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