ADMISSION FORM - JANUARY 2017 pate: VO Part-time PhD (Management) Energy 1 Ol& Gas Power Transportation Aviation Port & Shipping Part-time PhD (Engineering) o o Energy O Oil& Gas OD Power Transportation Aerospace Part-time PhD (Science) Health, Safety & Environment Part-time PhD (Legal Studies) Infrastructure Infrastructure Logistics & Supply Chain General Management Health, Safety & En Infrastructure Information Technology Mechanical Chemical Ament Affix Photograph Computer Science Earth Sciences IMPORTANT GUIDELINES: All the below mentioned fields are mandatory Please mention N/A wherever not applicable 1. Name [in Block Letters): 3, Correspondence Address: Tetephone No: [JO OOO0OO 4, Permanent Address: Telephone No: [JC] OO0000 5. Email: 6. Nationality: 7. Occupation: 8, Name of the Company: 9. Designation: 10, Employer's Address: 11. Telephone (Off): (] Gender MC] FL] others] Pin QOOOO00 mobite: J} OO OOOOO00 Pin QOOOO00 mobite: (] OO OOU00000 000000Class X Class XI Graduation Post Graduation Any Other Name of the Organization Gl Website Newspaper O Emailer 1 SMS © Magazine Any Other Declaration hereby slate hath arma an siete othe es ol my kau cas ry natn ond o be act ny cana sable tobe ancl by the Users. shal aide by the regulations othe ners of Patrlaum ana Energy Sates, ncuding ess code, and pected fetavora norms ine wih tbe Universe saci chart sa nse ey parent tal appa dae. Student's SignatureINFORMATION FORM FOR IDENTITY CARD IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please fillin BLOCK LETTERS, 1. Name of the Program: Part-time PhD [Management] Energy Transportation Infrastructure Ol&Gas Aviation Infrastructure General Mana Power Port & Shipping Logistics & Supply Chain Part-time PhD (Engineering) Energy Transportation Health, Safety & Environment 1D Ol&Gas Aerospace Infrastructure OD Power Information Technology Photograph Mechanical Chemical Part-time PhD {Science} Health, Safety & Environment Computer Science Earth Sciences G_ Part-time PhD (Legal Studies) 2. Duration of the Program: 1st January 2017 to 31st December 2019 3, SAP ID [For Office use only: (] OI OOOO00 4, Student's Name [in English Capital Letters}: 5. Father's Name: 6. Mother's Nai 7. Spouse's Name: 8, Correspondence Address: ‘OOUO00 Tetephone No: "(OOOO O000 mobite: J OO OOOOO00 9. Permanent Address: Pin FOOOO0 Telephone No: OO OOOO00 Mobite: (I OOI00000 10. Tetephone fort}: (JOO OO0000 M1. Emergency Contact No J OO OOOOOO000 12. Blood Group: (][] () Authorized Signatory Specimen Signature of the StudentINSTRUCTIONS FOR SENDING THE ADMISSION FORM PhD Programs Please send the filled in Admission Form along with: 1. Non-refundable Admission Form fees of 22,000/- {through demand draft) in favor of "UPES”, payable at Dehradun or you can pay by NEFT Transfer, . Xth & Xilth class certificates and mark sheets (photocopies should be self attested). te & mark sheets [photocopies should be self attested), ates & mark sheets (photocopies should be self attested). Any other degree/diploma/certificates {as mentioned in the application form. 1 copy of Research Proposal Bio-Data 2 passport size photographs affixed on the form. 1 passport size digital photograph and scanned signature. 10. Work experience certificatels). 11. Completed ID form. All these documents should reach us at the earliest at the following address: ‘Amar Matlani Head Sales University of Petroleum & Energy Studies Marketing & Communication Office 2nd Floor, 210,0khla Phase Il, Industrial Area,New Dethi -110020 Tel: +91-11-61730151-53 Fax: +91-11-61730154 www.upes.ac.in