Application for Admission to PhD Programme in Mathematics
A. Course & Discipline of Postgraduate Degree
B. Details of Demand Draft drawn in favour of Registrar, Central University of Tamil Nadu,
payable at Thiruvarur:
Name, Address & IFSC Number of the Issuing Branch
DD No.
Date
Amount
C. Have you cleared UGC NET or NBHM or DST INSPIRE fellowship or any other equivalent National Level Fellowship? YES or NO D. If you belong to Scheduled Caste (SC) or Scheduled Tribe (ST) or Physically Challenged (PC) or Other Backward Classes (OBC: Non-Creamy Layer) category, please put a tick mark in the appropriate box.
1. Candidate’s Name : (CAPITAL LETTERS)
2. Father’s Name (CAPITAL LETTERS) Sri
3. Mother’s Name (CAPITAL LETTERS) Smt.
4. Date of Birth : Date Month Year 1 9
5. Sex : Male Female 6. Identification Mark(s) : __________________________________________________________________________________ 7. Postal Address (For Correspondence) : _________________________________________________________ ___________________________________________________________________________________________ _________________________________________________ Phone/Mobile No. ___________________________ (with STD code) Email Address ______________________________________________________________
Merit Index (To be filled in by Office)
Affix identical & self-attested recent Passport Size Photograph Eyes and Ears must be visible. Do not pin or staple.
तमिऱनाडु केन्द्रीय मिश्वमिद्याऱय (संसद द्वारा पामरत अमिमनयि 2009 के अंतर्गत स्थामपत) CENTRAL UNIVERSITY OF TAMIL NADU (Established by an Act of Parliament, 2009) तंजािुर रोड/Thanjavur Road, मतरुिारूर/Thiruvarur - 610 004 : 04366 – 220311, : 04366 - 225312
ST
PC
OBC
SC
8. Permanent Address : _________________________________________________________ ___________________________________________________________________________________________ _________________________________________________ Phone/Mobile No. ___________________________ (with STD code)
9. Nationality : If Indian, indicate the State you belong to: Indian Foreign 10. Details of the Examinations Passed: (enclose the documentary evidence for the entries in these columns)
Name of the Examination
Board/University
Year of Passing/ Appearing
Subjects
Marks
Obtained
Max.
%
High School or equivalent Examination of 10th level
Intermediate or equivalent Examination of 10+2 level
Bachelor’s/Equivalent degree
Master’s/Equivalent degree
UGC NET/NBHM/ DST-INSPIRE fellowship/any other equivalent National Level Fellowship
11. Name of the institution from where you have passed the qualifying examination: ___________________________ 12. Have you ever been subjected to any disciplinary action? If so, state reasons, the punishment awarded and reference of authority awarding the punishment: _____________________________________________________________ 13. Whether previously/presently employed? If YES:
(i) Name of the Employer
(ii) No Objection Certificate of Employer
(iii) Whether leave for completing research will be sanctioned for the residence period
DECLARATION
I _________________________________, an applicant for admission to PhD in Mathematics do hereby solemnly affirm that all the particulars stated above have been filled in by me in my handwriting and all the information given in the application form and enclosed documents are true and correct to the best of my knowledge and belief. In case any information furnished by me is found wrong at any stage, my candidature be cancelled outright without giving me any further opportunity and any disciplinary action be taken against me. Place: ............................. Signature of the Candidate ____________________________ Date: ..............................
LIST OF ENCLOSURES: List the documents enclosed with the application form in the same order as given in the Information Bulletin.
1. Demand Draft drawn in favour of Registrar, Central University of Tamil Nadu, Thiruvarur, No. _______________________________ Dated _______________ Amount ____________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
4. _______________________________________________________________________________
5. _______________________________________________________________________________
6. _______________________________________________________________________________
7. _______________________________________________________________________________
8. _______________________________________________________________________________
9. _______________________________________________________________________________
10. ______________________________________________________________________________
Total number of documents enclosed NOTE:
1. The Fellowship holders in Sl. No.10 above may have to appear in an Entrance Test apart from Interview. This is subject to the clarification by UGC in this regard.
2. The candidates have to fill in the application in his/her handwriting.
3. The application fee is Rs.500/-. For Women, PWD, SC/ST candidates, the application fee is Rs.300/-.
4. Ensure that the Demand Draft fulfils the following requirements:
(i) It is in favour of Registrar, Central University of Tamil Nadu payable at Thiruvarur.
(ii) It has the details such as Date of issue, Name & IFSC no. of the issuing branch, Name & IFSC no. of the drawee branch, Signature of the authorized person, Amount in words and figure, Names of the Applicant and Programme applied for on the back of the DD.
5. Incomplete applications or applications without relevant certificates/documents in support of any information desired in the application form will not be considered and will be rejected outright.
6. Canvassing in any form will also lead to rejection of application.
7. Please superscribe the envelope containing your application as Application for Admission to PhD in Mathematics
8. Last date for submission of the filled in application to the following address is 31-08-2013:
The Registrar, Central University of Tamil Nadu, Collectorate Annexe, Thanjavur Road, Thriuvarur - 610 004.