NATIONAL INSTITUTE OF

FIRE AND SAFETY MANAGEMENT

ADMISSION FORM Form No.-
Instruction:- 1. Form should be filled in block letter and black ink only.
2. Incomplete application will be rejected without any further notice.
COURSE NAME --------------------------------------------- TO
COURSE CODE --------------------------------------------- H O
SESSION/YEAR --------------------- MEDIUM ------------------ P
CENTRE NAME ---------------------------------------------
CENTRE CODE --------------------------------------------- STUDENT SIGNATURE

NAME OF THE APPLICANT

FATHER’S NAME

MOTHER’S NAME

MALE/FEMALE/OTHERS
DATE OF BIRTH GENDER

NATIONALITY CAST GEN OBC SC ST OTH.

EMPLOYEED STATUS UNEMPLOYEED GOVT. PVT. SELF STUDENT

HEIGHT BLOOD CHEST I N

K. G. WEIGHT C. M. CH
GROUP MSMT.
RELIGION HINDU MUSLIM CHRISTIAN SIKH OTHERS

AADHAAR NO.

PERMANENT ADDRESS

PIN CODE

CITY STATE

EMAIL ID
MOBILE GUARDIAN
NO. NO.

PRESENT ADDRESS

PIN CODE
CITY STATE
EDUCATION QUALIFICATION (ENCLOSE DULY ATTESTED TRUE PHOTOCOPIES OF THE ORIGIONAL )

NAME OF THE NAME OF THE SUBJECT/ MARKS TOTAL YEAR OF

BOARD/ PERCENTAGE
EXAMINATION STREAM OBTAINED MARKS PASSING
UNIVERSITY

APPLICANT’S DECLARATION
I hereby declare that aforementioned information and enclosed documents above are true and complete to the best
of my knowledge and belief..............................................................................................................................................
I shall submit any other documents that may be required by the institute in future.............................................................
I also agree that the institution is empowered to cancel my admission, forego the fee deposited and also the claim for
admission, if any information furnished by me is found to be incorrect, misleading and counterfeited.............................
I further declare that the attested photocopies of the certificates submitted by me at the time of admission are the
true copies of the originals........................................................................................................................................................
I am aware of the fact that the course I desire to join is autonomous course run by the National Institute of Fire and
Safety Management..................................................................................................................................................................
I also declare that after paying the fees installment no refund will be asked by me at any circumstances. I shall not
ask for its refund, even in event of cancellation of admission by me. If I cancel my admission during the training/
course due to any kind of reason, I would be pay all academic fees at any manner. All of the documentation work or
pending documents will be done/issue after completion of fees and dues. ..........................................................................
I have read and understood that my fire and safety, health and environment, disaster management, related training
is being provided and arranged by the College/Institute/Management as a requirement of my program of study.
I assume with full knowledge the danger in my participation in training activities and do so at my own risk. So hereby
I declare that college/institute or management will not be responsible for any kind of injury or accident during the
training which may result in me being injured or death.........................................................................................................
TERMS AND CONDITION
Each & every student need to qualify internal exam for appearing final exam.................................................
Mis-conduct of college/institute behavior is strictly prohibited. If any guilty found would be terminated from
college/institute. ....................................................................................................................................
No student can wander in college/institute premises without reasonable cause..............................................
If any student is absent without application he/she shall be levied Rs.100 fine and undisciplined like without
shaving, unerasable hair style, nails shall be levied Rs. 50 fine.........................................................................
All students must be attentive and diligent in class as well as mobile phones must be in silent mode or
switched off............................................................................................................................................. ............
I have read above mentioned clauses carefully and agreed with rules-regulations and condition
of the institute/college....................................................................................................................

Signature Thumb Impression

APPLICANT SIGNATURE WITH THUMB IMPRESSION
DATE PLACE

FOR OFFICE USE ONLY

ROLL NO. --------------------- REGISTRATION NO.

----------------------
ADMISSION DATE ----/----/--------