Admitted to (M. Sc./ Ph. D.

) / Not Admitted Downloaded form Year 2010-11

Institute of Science, Mumbai-32 , Application For The Admission
FOR M. Sc. (By Papers/Research) and Ph. D.
MARKS OUT OF CATEGORY GEN.MERIT ENTERED/VERIFIED
/600 /800 LIST NO. BY

Photograph
The Director,
Institute of Science, 15, Madam Cama Rd, Mumbai 40032.
I have read the Prospectus. I hereby agree to abide by all rules regarding admission, Fees, attendance. I
hereby agree, if admitted, to abide by the rules & regulations at present in force or that may hereafter be enforced.
I undertake that I shall maintain the discipline and I shall not indulge in ragging activity of any kind. I submit
herewith a Provisional Eligibility Certificate from Mumbai University (For other University Graduates).

Course applied for:[ Write M. Sc. (by Papers/Research) / or Ph.D.] Subject …………………………
Specialization : (In order of preference) (For Chemistry, Physics, Zoology, Botany Students only) ( See Prospectus)

(1)………………………(2)……………………………….(3)………………………………. (4)
……………………………….
Name of the Student : (IN BLOCK CAPITALS):

:……………………………………………………………………………………………………………………………………
(Surname First Name Middle Name )

Mother’s name: ----------------------------------------------------------------------------------------------------------------------------------

Male / Female Nationality: ………Category: Open/O.B.C./ S.B.C./S.C. / S.T ./ N.T. /D.T / V.J---------
Date of Birth:…………………………………………………………………………………………………………………(Tick as applicable)

Name of the Guardian/Parent, Address, Occupation . ………………………………………………………. …………………

…………………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………Tel No.…………………………………………
Present Address of the Student: ………………………………………………………………………….…………………………………
………………………………………………………………………………………………………………………………………………………
Mobile No. ………………………………………………………………Email address : ……………………………..……………………..
State whether you have applied or intend to apply for admission to any other course/ institution.

…………………………………………………………..
Demand draft No: Date: Bank & Branch
Qualifications: Furnish full details and explain breaks, if any, in educational career submitting evidence in support .
Degree Month &Year Subject at Marks Class % of Attempt &
of passing (B.Sc)/(M.Sc) Obtained/out obtained Marks Name of
of University
H. S. C./ XII ------------------
T. Y. B. Sc. /600
(Specify Univ.
/800
of
Mumbai /Other
M.Sc.
Addl. Qualification
B.Ed/M.Phil
Instructions: 1 Form must be submitted with a Demand Draft/Pay order drawn, in favor Yours faithfully,
of “Director, Institute of Science, Mumbai” payable at Mumbai of amount Rs. 300/-
2 Submit true copies of all qualifications, caste certificate etc. with application .. [-------------------------------------------------------]
3.Original certificates must be brought at the time of Admission. Round. . Applicant student’s Signature
4.reserach students should submit self addressed stamped ( Rs. 5.00 ) envelope with application. Date: