NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA, SURATHKAL

P.O. SRINIVASNAGAR, MANGALORE-575 025

Registration No.
(for office use only)

Admission to M.Sc. (Physics) Programme

2015-16
Particulars of D.D. drawn
Name of the issuing Bank ______________________________
Drawn at ____________________________________________
D.D. No. ____________________ dated ___________________
Rs. _______________

Category: OC / SC / ST / OBC / PWD

(Tick mark the appropriate)

Instructions:

1. Fill your address in the address slips supplied and Registration Memo supplied.
2. Enclose self attested photo copies of marks card and other documents.
3. Candidates are appearing for the final degree exam of May/
June 2015 may also apply provided they can produce proof of their eligibility
for admission by September 15, 2015.

Affix recent Passport size

photo to be with self
attestation

4. Late/incomplete/Applications without DD are liable to be rejected.

5. Last date for submission of filled in application is 15.05.2015.

1. Name of the Candidate in full (in Block Letters

as mentioned in the Degree Certificate):

a. Permanent:

2. Address of the applicant (with pin code):

b. Correspondence

c. Telephone with STD Code or contact number/

Mobile No. :
d. Email (if any):
3. Name and address of Father/Mother (or Guardian
if the parents are not alive, state relationship of
Guardian)

4. Occupation of Father/Mother/Guardian
Annual Income
1

5. a. Religion of the Candidate:

Caste/Subcaste

b. Do you belong to Scheduled Caste/Tribe/OBC(Tick Mark)

If yes, enclose a copy of the Caste Certificate from
Competent Authority

Yes / No

SC / ST / OBC

c. Place of domicile
d. Nationality

6.

e. Do you belong to Persons with Disabilities (PWD) group?

(if yes, enclose copy of certificate issued by the Competent Authority)

Yes / No

f.

Yes / No

Are you a Sponsored Candidate?

(If yes, forward your applications through proper channel)

Date of Birth (Copy of the Supporting document to be enclosed)

In Figures:
In Words:

7. Academic Record:
a. i. Qualifying Degree Examination Passed

ii. Institute where he/she studied

iii. Period of study

: from __________________ to ________________

iv. University

b. Marks obtained in the Qualifying Examination (Bachelors Degree):

Year of Passing
I Year

II Year

III Year

Marks obtained

I Sem.
II Sem.
III Sem.
IV Sem.
V Sem.
VI Sem.

8. Details of Practical Training under gone, if any, other than that

required for graduate Course. Attach extra sheet if necessary.

Max. Marks

Percentage

Class/ Division

9. DECLARATION OF CANDIDATE
I hereby declare that to the best of my knowledge, the particulars furnished in this application are correct.
I am willing to forfeit the seat secured, if any information provided by me is false.
If selected for admission, I undertake to abide by the regulations of admission and Rules of the Institute, and the
Academic Regulations that govern the programme of study.
Place:
Date:

Signature of candidate

Documents (photo copies) to be enclosed.

1. Copy of the Marks Card of Qualifying Exam (all years- all semesters)
2. S.S.L.C./ X Std. Marks Card (for date of birth).
3. Caste Certificate issued by Competent authority for SC/ST.
4. Persons With Disabilities (PWD) Certificate, if applicable.
5. OBC Certificate in the Central Govt. format issued by competent authority in case of OBC.
6. Sponsorship Certificate (if sponsored)
7.

Two Self-Addressed Envelopes with Stamp each worth Rs 17/- (For postage in Mangalore) / Rs 39/- (for Postage outside
Mangalore).

10. FOR USE BY FORWARDING AUTHORITY (EMPLOYER)

Sponsorship (Deputation) Certificate/
The applicant (name) .has been a permanent staff of
this

Institute/Organization

from

..

and

has

..

years

of

experience

(teaching/R&D/industry).
1.

Sponsorship/ (Deputation) certificate:

He / She is sponsored (deputed) with full/half/no salary (Strike-out whichever is not applicable), for full time study
in National Institute of Technology Karnataka, Surathkal.
2.
The candidate and his/her sponsorship (deputation)/ NOC will not be withdrawn before the completion of
the course/programme.

Office Seal

Station:

Signature of the Employer

Date :

Name:

Designation:

(Note: Sponsorship certificate should be submitted in the same format as indicated in this application form
duly signed by the Employer/ Sponsoring Institute Head and seal.)
3

NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKA

SURATHKAL, POST SRINIVASNAGAR, MANGALORE- 575025,
KARNATAKA STATE.

REGISTRATION MEMO.
Date:......... 2015
Ref: Application for admission to M.Sc.(Physics) Programme
The Registration No. assigned to your application for admission is noted below, which must be quoted in all
correspondences connected with your application. No notice will be taken of any communication or document sent by you
unless it bears your Registration Number.
Registration Number:

M.Sc.(Physics) ........../2015-2016

Asst. Registrar (Academic)

Affix
Stamp
Rs.6/To:
The Asst. Registrar (Academic),

Mr./Ms. ________________________

N.I.T.K., Surathkal

______________________________

Post Srinivasnagar

_______________________________

MANGALORE - 575 025.

_____________________________

(Write address of the candidate)

To

To:
_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

Pin Code ________ (__________ State)

Pin Code ___________ (________State)

To

To:
_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

Pin Code _________ (__________State)

Pin Code __________(__________State)

APPLICATION FOR M.Sc.(Physics)

BY REGISTERED POST

ADMISSION 2015

From:

To:

____________________________

The Asst. Registrar (Academic),

____________________________

N.I.T.K., Surathkal

____________________________

Post Srinivasnagar

____________________________

MANGALORE - 575 025.

____________________________