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Saurashtra University, Application form for Admission Ph.D. Course in Subject To, Professor & Head, Department of ..

Saurashtra University, Rajkot 360 005 Sir, I submit this application for admission in Ph.D. course for the academic year 2012 / 2013 I hereby agree, if admitted, to conform the Rules and Regulations of the Department, presently in force or that may be thereafter from time to time and I undertake that so long as I am a student of the Department, I will do nothing either inside or outside the Department that will interfere with its orderly management and discipline. I give below the necessary particulars. All the statements made by me are correct. Yours faithfully,

Place : Date :.. (Signature).

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Name : Mr./Miss/Mrs. (In Block LETTERS) (Surname) (name) Fathers / Mothers Spouses Name .. Address for Correspondence.. .. Permanent Address . Contact Phone No.(with code No.)

2.

3.

Sex :

Male :.

Female :.

4.

Date of Birth : Age : .. Place of Birth : District :. State :. Mother Tongue :

5. 6.

Nationality : Indian Foreign Category : Gen. SC ST SEBC OTHERS (Attach appropriate certificate from competent authority in case you belong to SC/ST/SEBC) Are you Physically Handicapped ? Yes No (If yes, attach appropriate certificate). From which University you have obtained your graduate degree ? Saurashtra Other University Other University University of Gujarat State of other state Academic Information (Qualifying Examination) University Year passing of Subject offered Marks in % Class Obtained Obtained

7. 8.

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Examination T.Y. Post Graduate Degree M.Phil. Ph.D. Eligibility Test. Other

(Attach True Copies of the Marksheet) 10. 11. 12. 13. 14. Name of College last attended (from where the transfer is to be obtained) Name of the University last attended (from where Migration Certificate be obtained) Do you want admission in the hostel? Are you engaged with any job / business? If yes, give details (Timings etc.) Yearly income of Father / guardian.

Note :-

Signature of Candidate

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