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Programme applied for Ph.D. (Full Time)/ Ph.D. (Part Time)/ M.S. (by Research):
(Write whichever is applicable)
Department/ School
Discipline/ Specialization
3. Personal Details:
(i) Name (in capital)
(ii) Father’s Name
Address for
(iv)
correspondence
Pin - …………………………………. E-mail ID: ………………………………………
Telephone: …………………………………. Mob. No……………………
Permanent Address
(v)
4. Educational Qualifications:
Please give the particulars of all the examinations passed and degrees obtained commencing with high
school leaving examination (Matriculation/10th standard)
Exam/ Degree
Year of % marks
Sl. No. obtained (with Subjects /Branch Board /Institute/ University Division
passing /CGPA
Discipline)
(i)
(ii)
(iii)
(iv)
(v)
(i)
(ii)
I hereby declare that the information given above is correct. In case any of the information given by me
is found incorrect, my application is liable to be rejected / admission is liable to be cancelled.
Further, I assure that if admission is given to me, I shall abide by the rules and regulations, statutes,
and ordinances of the Institute and changes incorporated therein from time to time and shall maintain the
discipline of the Institute.
Date:
Place: Signature of Competent Authority with official seal
Note: At the time of admission, all certificates and documents in original including migration & character certificate should be produced.
1. Name: …………………………………...........
Recommended/Not Recommended