Reg. No.

_____________
MAULANA AZAD NATIONAL INSTITUE OF TECHNOLOGY
BHOPAL – 462051 (M.P.) INDIA Photograph
APPLICATION FORM FOR ADMISSION IN M.Tech./MUDP
Please read the instruction given in the information Brochure before you fill up the form
Tick (√ ) the relevant box wherever provided

1. GATE : 2. Aggregate % at 3. Category 4. GATE 5. Payment Details :

Score : ……………… degree level (SC/ST/OBC/PH/ IPO/DD No. ………...
OFFICIAL USE

Gen.)
Year : ……………….. Drawn on …………..
Sponsored Amount Rs………….
Discipline : …………
Date …………………
Rank : ……………….
Sch. No. ________________________ Branch: ………………………………………… Date of Admn……….

TO BE FILLED BY THE CANDIDATE

1 Name (in capital)
2 Date of Birth Place of Birth :
3 Father’s Name
4 Mother’s Name
5 Category Gen./SC/ST/OBC/Disabled ……………………… Blood Group …………………….
6 Religion
7 Branch at UG Level
8 Aggregate Percent Exam : Total Marks :
of marks in the
qualifying UG Exam Percentage :
9 Details of GATE
a) Year of Passing ………………….
Examination
b) Discipline of GATE ………………
c) Percentile …………………………
d) GATE Score ……………………..
10 Preference for M.Tech. Courses (Please write 1,2,3………)
S.No Name of Branch Preference S.No Name of Branch Preference of
of Branch Branch
1 Power System 12 Information Security
2 Hydro power Engineering 13 VLSI
3 Thermal 14 Electrical Drives
4 Engg. Material 15 Geo-Informatics and its
Applications
5 Geotechnical Engineering 16 Structure
6 Stress & Vibration 17 Bio-informatics
7 Digital Comm. 18 Nano Technology
8 Energy 19 Industrial Design
9 Urban Development & 20 CSE
Planning (MUDP)
10 Maintenance Engineering & 21 Transportation Engineering
Management
11 Environmental Engineering
11 Address for
correspondence

Email ID : …………………………… Telephone / Mob. No. …………………

12 Permanent Address

Telephone / Mob. No. …………………

13 Marital Status Single Married
14 Occupation of father/
Guardian & Address

Contact Phone / Mob. No. …………………

15 Have you ever Yes No if yes, give the particulars of the programme earlier attended
(a) studied and and the reason for discontinuation
discontinued your ………………………………………………………………………………………………
studies at MANIT ………………………………………………………………………………………………
Bhopal
(b) Whether any
disciplinary action
taken during
college/institutions
attended earlier
and/or police case. If
so, the details there
of
(c) Gap in studies
mentioning the
period with reason
(d) Names & address of
1. ……………………………………………………………………
two persons from
whom the applicant ……………………………………………………………………
has attached
2. ……………………………………………………………………
testimonials
……………………………………………………………………

16. Educational Qualifications :

(a)
Exam/ Degree Subjects/ Board/ Year of Division Total marks % marks/
Branch University Passing obtained CGPA
a 10th (Matric)
b 10+2/Equivalent
c B.E./B.Tech./AMIE/
B.Arch./B.Sc./M.Sc.
d Any other
examination
e Name of College/Institute last attended :

(b)
GATE (Year of Percentile Total Marks Rank
Passing)
17. Experience in Chronological order :

Name of Employer Organization Nature of Work Experience (From dt. to dt.)

Experience (For
Sponsored)

Details of Registration fees :

Postal Order/ Bank Draft No. Rs.
Issuing Bank/ Post Office Dated

Date : …………………… Signature

Place : …………………. Name : ……………………….

List of enclosures (Attested Photocopies):

a) 10th Marksheet/Certificate Yes/No

b) Hr Sec./Intermediate Marksheet/Certificate Yes/No
c) B.E./B.Tech./AMIE/M.Sc./B.Arch./B.Sc. Marksheet Yes/No
d) GATE score card and GATE Admit card Yes/No
e) Sponsorship Certificate (For sponsored Candidate) Yes/No
f) No Objection certificate (For Sponsored Candidate) from present employer Yes/No
g) Caste certificate (For SC/ST/Backward classes/Disabled) in Central Govt. format Yes/No
h) Character Certificate Yes/No
i) Transfer Certificate Yes/No
j) Migration Certificate Yes/No
k) Draft/I.P.O Yes/No
l) Gap Certificate Yes/No
Declaration by the Applicant

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,
ordinance of the Institute and changes incorporated therein from time to time and shall maintain the discipline of
the Institute.

Place : …………………. Signature of the candidate

Date : ………………….. Counter Signature of Father/Guardian

 To be filled up by employers sponsoring candidates

1. Name of the Employing : __________________________________

Organization

2. Type of Organization : Central Government State Government

Government Autonomous Organization
Public Sector Enterprise Private Sector Industry

3. Address of Administrative : __________________________________________

Officer/HR Manager __________________________________________
Phone: ______________Fax:__________________
Email: _____________________________________

4. Designation of the employee : __________________________________________

Seeking admission in MANIT

5. Employment Details :
a) First joined on (date) : __________________________________________

b) Holding the present : __________________________________________

Position since (date)
c) Nature of Job : __________________________________________
(R & D, Design, Production, Marketing, Administrative, Teaching)

Certified that, Mr/Ms.___________________________________________ employed as

________________________ in this organization is sponsored for admission to Full time M.Tech. programme of
MANIT, Bhopal. He/She has been employed in this organization for the past_______ years in a regular cadre. If
selected as a sponsored candidate the organization has no objection to his/her undergoing two years of full time
studies at MANIT, Bhopal

__________________________ ____________________________
Signature of Applicant Signature of Competent Authority

Name, Designation

Verification Sheet (For office use only)

1. Name : ……………………………………….2. Category : Gen./SC/ST/OBC/DISABLED : …………………………

3. Branch at BE/B.Tech./AMIE/B.Arch. ……………………………………………..
4. BE/B.Tech./AMIE/B.Arch year of passing ………………………. Percentage ……………………
5. GATE : Year of passing …………………… Percentile ……………………….

Verified and admitted provisionally to the First semester Full Time course in ………………………………………...
List of formalities to be completed ………………………………………………………………………………………….

by date ……………………………..

(Signature of candidate at the time of admission) (Signature)

Date : ………………… (Member of Admission Committee)
Date : ………………