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Duplicate Addmission Form

This document is an application form for various fire and safety management programs offered through a collaboration between the National Institute of Fire Engineering and Safety Management (NIFS) and Annamalai University. The application requests basic personal information such as name, address, date of birth, qualifications, and a declaration of accuracy. It outlines the review process for verifying certificates and admission confirmation. Fees for prospectus and application forms are provided at the bottom.

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gaganbhatti652
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26 views

Duplicate Addmission Form

This document is an application form for various fire and safety management programs offered through a collaboration between the National Institute of Fire Engineering and Safety Management (NIFS) and Annamalai University. The application requests basic personal information such as name, address, date of birth, qualifications, and a declaration of accuracy. It outlines the review process for verifying certificates and admission confirmation. Fees for prospectus and application forms are provided at the bottom.

Uploaded by

gaganbhatti652
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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NIFS

NATIONAL INSTITUTE OF FIRE ENGG. & SAFETY MANAGEMENT


Technical Collaboration with Annamalai University
(Government University with “A” Grade)
Approved by UGC, AICTE & Ministry of HRD, Govt. of India

APPLICATION FOR
B.Sc. (F&IS) DFS PGDFS Attach
Latest Color
Photograph
MBA (SM) DHSE PGDHSE

1. Name in CAPITAL LETTERS (In English): as per +2 Certificate

Mr. / Ms. / Mrs.


(First Name) (Middle Name)

(Last Name)

2. Address in CAPITAL LETTERS (The address to which communications are to be sent)

District
Phone No.
With STD Code
State
PIN CODE

3. Date of Birth (in the Christian era) Date Month Year E-Mail ID
(as entered in the School Leaving Certificate) 1 9
4. Sex: Male Female Nationality:
5. Marital Status: Married Unmarried
6. Name of the Father/Mother/Husband/Guardian:
7. Occupation: Government Non-Government Others
8. Are you presently undergoing any other programmes, in any institution (including DDE) If yes, give details?
Yes No
9. Qualifying Examination Passed:
Name of the Duration of the Name of the University / Registration No.
% age of Marks Class Obtained
Examination Course Board And Year
10th

10 + 2

Others
DECLARATION

i) I declare that the particulars given above are correct and I submit myself to the disciplinary and regularly
jurisdiction of the authorities of the University who are vested with the rights to exercise discipline under the Act,
the Statutes, and the Ordinances, and will strictly observe the rules and regulations that have been framed there
under by the University.

ii) I hereby agree that with regard to disputes arising in all matters including admission, returning of original
certificates after verification, sending of lessons, PCP’s response, sheets, examinations, remittance of fees etc.
only the courts and tribunals having jurisdiction over Annamalai Nagar and not over any other place, shall have
jurisdiction for the purpose of filling a suit or preferring complaint under the Consumer Protection Act or any
other law for the time being in force or taking any legal proceedings against the Directorate of Distance Education
or the Controller of Examinations, Annamalai University. I understand that the fees once deposited will not be
returned under any circumstances.

_______________ ______________________ ___________________


Date: Signature of the Parent Signature of the Applicant

For Office Use Only


( ELIGIBLE NOT ELIGIBLE )

CERTIFICATES VERIFIED REMITTANCE PARTICULARS

1) 10, 10+2 Mark List Name of the Bank :


2) 10, 10+2 Pass Certificate Draft/Challan Number :
3) Transfer OR Migration Certificate Amount : Date:

Provisionally selected for admission subject to confirmation by the Director

Official-in-Charge Supdt./Sr. Supdt. A.O./L.O./S.O.

Admission Confirmed

Official-in-charge Section Head DIRECTOR

One Yr Course - Cost of Prospectus/ Application Form Rs. 150/- by Post Rs. 190/-
Two Yr Course - Cost of Prospectus/ Application Form Rs. 250/- by Post Rs. 290/-
Three Yr Course - Cost of Prospectus/ Application Form Rs. 350/- by Post Rs. 390/-

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