Year of Admission: Roll No.

REGISTRATION NO. MERIT NO. Student No. (Not to be filled by candidate)

ADMISSION FORM Affix Recent

(To be filled in by candidate’s own handwriting) Passport size
colour
School Name:________________________ Photograph

Program Name: _________________________

A.1. NAME: Mr./Ms. __________________________________________________________________

(In Block letters) Surname Own Name Father’s/Husband’s Name Mother’s Name

AS PER 12th (10+2) OR EQUIVALENT MARKSHEET; SAME NAME WILL APPEAR IN THE
MARKSHEET AND CERTIFICATE. IF YOU DO NOT HAVE LAST NAME YOU MAY ENTER ( . )
DOT.
D D M M Y Y Y Y
B.1. AGE: Yrs. YRS Months, DATE OF BIRTH

B.2. Blood Group: ___________

B.3. AADHAAR NUMBER: ______________________

B.4. MOTHER TOUNGUE: _______________

B.5. RELIGION: _____________________

MINORITY ( IF ANY):______________

(B6 to B11 Mark  or X )

B.6. GENDER: Male Female

B.7. CATEGORY: Open SC ST OBC

NT VJ Other (Please Specify ____________)

B.8. NATIONALITY: Indian Others (If Other, Specify) ________________

B.9. DOMICILE: Maharashtra Others (Specify the state) _____________

Region: Whether Belong to East West North South

B.10. 12th Board: Maharashtra I.B. ICSE CBSE Other

(If Other, Specify) _______________

B.11. DIFFERENTLY ABLED: YES NO

(IF YES PLEASE SPECIFY): _________________

B.12. Scholarship Program for Diaspora Children (SPDC) : YES NO

If yes: Choose following option,
1) Children of Persons of Indian Origin(PIO)
2) Children of Non-Resident Indians (NRI)
3) Children of Indian Workers in Emigration Check Required (ECR) countries studying outside
India
4) Children of Indian Workers in Emigration Check Required (ECR) countries studying in India

C.1. ACADEMIC PERFORMANCE (Stages of Education)

SSC DETAILS: -

10th Percentage/Grade Point: _______________ 10th Enrollment No: _________________

10th School Name: ___________________________________

10th Board: ___________________ Examination State: _____________________

10th Marks Obtained: ____________ 10th Marks Out of: __________________

10th Completion Month & Year of Passing: _____________________________

HSC/DIPLOMA DETAILS: -

12th/ Diploma Stream: ___________________

12th / Diploma Percentage/Grade Point: _______________ 12th Enrollment No: _________________

12th / Diploma School Name: ___________________________________

12th / Diploma Board: ___________________ Examination State: _____________________

12th / Diploma Marks Obtained: ____________ 12th / Diploma Marks Out of: __________________

12th / Diploma Completion Month & Year of Passing: _____________________________

C.2. NAME OF THE COLLEGE/INSTITUTE LAST ATTENDED __________________________

______________________________________________________________________________________________
APPLICANT’S ADDRESS

D.1. APPLICANT’S PRESENT ADDRESS: ____________________________________________

________________________________________________________________________________

________________________________________________________________________________

PHONE (with STD Code): ______________________ Mobile: _______________________

E-Mail Address: _____________________________________________________________

D.2. PERMANENT ADDRESS: ______________________________________________________

________________________________________________________________________________

_______________________________________________________________________________

PHONE (with STD Code): _____________________ Mobile: ________________________

E. FAMILY BACKGROUND

E.1. FATHER’S NAME: _______________________________________________

E.2. OCCUPATION: ________________________________________________________________

E.3. OFFICE ADDRESS: ___________________________________________________________

_______________________________________________________________________________

Email Address: _______________________________________________________________

Office Phone: __________________________________ Mobile: __________________________

E.4. MOTHER’S NAME: ____________________________________________________________

E.5. OCCUPATION: _______________________________________________________________________

E.6. OFFICE ADDRESS: ___________________________________________________________________

_______________________________________________________________________________________

Email Address: ________________________________________________________________

Office Phone: _________________________________ Mobile: _________________________

E.7. ANNUAL FAMILY INCOME: _____________________________________________________

E.8. LOCAL GUARDIAN’S NAME: ________________________________________________________

ADDRESS: ___________________________________________________________________________

____________________________________________________________________________________

Email Address: _____________________________________________________________________

Tel: ____________________________ Mobile: _________________________________________

(Kindly intimate in writing to Admission office, if there is any change in address or telephone no .)
Declaration by the Candidate and Parents:

1. I fully understand that if Leaving / Transfer & Migration Certificate is not submitted by due date, my admission will stand

cancelled automatically and Fees will be refunded as per prescribed refund rule.

2. I fully understand that the admission to the programme will be made depending on my merit and availability of a seat.

3. I fully understand the rules for cancellation of admission and that fees once paid will be refunded as per the rules applicable at

that time and I have been informed about the same while taking the admission.

Refund Rules on cancellation of admission:

Refund Rules: The Schedule of refund of fees will be as follows as per UGC rule October 2018:
If a student chooses to withdraw from the program of study in which he / she is enrolled, the institution concerned shall
follow the following five-tier system for the refund of fees remitted by the student.
Percentage of Refund of
Sr. No. Point of time when notice of withdrawal of admission is served to HEI
Aggregate fees*
(1)
100% 15 days or more before the formally-notified last date of admission

(2) 90% Less than 15 days before the formally-notified last date of admission.
(3)
80% 15 days or less after the formally-notified last date of
(4) 30 days or less, but more than 15 days, after formally-notified last date of
50%
admission
(5)
00% More than 30 days after formally-notified last date of admission
*(Inclusive of course fees and non-tuition fees but exclusive of caution money and security deposit)
In case of (1) in the table above, the deduction will be 5% of the fees paid as processing charges from the refundable
amount, subject to a maximum of Rs 5,000/-.
Note: The above refund rules are subject to revision as per UGC notification (as applicable).
Candidates to refer Important Dates of the respective programme.

4. I hereby declare that I am the same person who has given NMIMS Personal Interview for securing admission in

NMIMS University. In case of any dispute my admission will get cancelled and fees paid by me will be refunded as per

prescribed refund rule.

5. I fully understand that the Vice Chancellor/Registrar, of the NMIMS or the competent authority will have full liberty to

expel and/or debar me from the Institute if I am proved guilty of using unfair means during examination, admission

process etc

6. I fully understand that in case of grade and/or grade points of the degree programme, it is the candidate’s responsibility to

convert the grade and/or grade point into marks and submit it at the time of admission.

7. If at any stage, it is found that I do not satisfy the eligibility criteria or the information furnished by me is incorrect,

then my application for the admission of the Programme, even if selected and fees paid, will stand cancelled and fees

will be refunded as per prescribed refund rule.

 8. I hereby undertake that I shall pursue the studies at NMIMS and shall not do anything inside or outside the NMIMS, which may

result in disciplinary action against me.

9. I fully understand that I must put in minimum 80% of the attendance for each subject in the absence of which I will not be

eligible to write the exams for the subject / readmission in same year of program as per rules prevailing & as amended from

time to time.

10. I hereby agree to observe rules relating to Library, Computer Lab, I-Card and Code of Conduct of NMIMS which are in force

and amended from time to time.

11. I am aware that ragging is banned in the Institute and if I am found indulging in ragging I am liable to be punished

appropriately which may include expulsion from the Institute.

12. The information furnished by me in the application is true to the best of my knowledge and belief. I hereby declare that there

are no criminal cases either pending or in process against me.

13. I hereby solemnly declare that I have read and understood all the Rules of admission and cancellation of admission and I have

consulted my parents / guardian and after fully understanding the Rules I have filled in this application.

I have checked all the entries in this application. They are true; I have kept all enclosures ready to be presented on demand if

admitted. I agree to comply with the rules of the University.

14. All the disputes are subject to Mumbai Jurisdiction.

I agree and will abide by the rules and conditions of the University

_____________________

Signature of the Student

Place: ____________________________ I affirm that my son / daughter will abide rules and conditions of the University

Date: ____________________________ ______________________

Signature of Parent / Guardian

 FOR OFFICE USE ONLY

Checklist for Verification of Certificates:

Yes No
1. SSC Marksheet and Passing Certificate

2. HSC Marksheet and Passing Certificate

3. Leaving / Transfer Certificate from School/College last attended (Original)

4. Migration Certificate (Original) (Applicable for candidates outside Maharashtra)

5. AIU (University Equivalence) Certificate (For IB Board Only)

6. Transcript (For IB Board Diploma awarded only)

7. Medical Fitness Certificate (In Original signed by Registered Medical Practitioner)

8. Gap Certificate (if applicable)

9. Learning Disability (if applicable)

10. Aadhar Card / E-Aadhar Card

Remark :

___________ ___________ ___________ ______________ ___________________________

Checked by Verified by Dy. Registrar Sap Entry Registrar/Vice Chancellor

Fees received vide Receipt No. _________ dated _______________ for Rs._______________

By Demand Draft No. _________________ dated _____________ drawn on _____________________

Received by ________________________