Professional Documents
Culture Documents
Registration No.
(for office use only)
Rs. _____________
Category: OC / SC / ST / OBC / PC
(Tick mark the appropriate)
a. Permanent:
b. Correspondence
4. Occupation of Father/Mother/Guardian
Annual Income
Caste/Subcaste
Yes / No
SC / ST / OBC
c. Place of domicile
d. Nationality
e. Do you belong to Physically Handicapped (PH)/Physically Challenged (PC) group?
(if yes, enclose copy of a medical certificate from a DMO)
6.
Yes / No
7.
Academic Record:
a. i. Examination Passed
M.E./M.Tech./M.Sc./MBA/MA
any other (Attach all marks card copy of degree certificate)
ii. Specialisation
v. University
Year of
Passing
I Year
II Year
I Sem
II Sem
III Sem
IV Sem
Marks/Grade
obtained
Max.
Marks
Percentage
Class/
Division
CGPA
8. .Details of Practical Training under gone, if any, other than that required for graduate Course. Attach extra sheet
if necessary.
9. Professional/research or other Experience (Enclose Copies of Certificates from Employer)
Employer
Period
Salary
Signature of candidate
Place:
Date :
Name
Relationship
Institute/Organization
from
..
and
has
..
years
of
experience
(teaching/R&D/industry).
(a) Sponsorship/(Deputation) certificate:
He/She is sponsored (deputed) with full/half/no salary, for full time study/research in National Institute of
Technology Karnataka, Surathkal.
The candidate and his/her sponsorship (deputation)/ NOC will not be withdrawn before the completion of the
course/programme.
Official Seal
Station:
Date :
Name:
Designation:
(Note: Sponsorship certificate should be submitted in the same format as indicated in this application form
duly signed by the Employer/ Sponsoring Institute Head and seal.)
1. Full Name
2. Student Category :
3. Qualification
Full time
M.Tech.
M.Sc.
Other
OC
SC
ST
PC
OBC
Teaching
Research
Field/Industry
REGISTRATION MEMO.
Date:......... 2013
Ref: Application for admission to Ph.D. Programme
The Registration No. assigned to your application for admission is noted below, which must be quoted in all
correspondences connected with your application. No notice will be taken of any communication or document sent by you
unless it bears your Registration Number.
Registration Number:
Ph.D. ......../2013-2014
Affix
Stamp
Rs.6/To:
Mr./Ms. _______________________
N.I.T.K., Surathkal
_______________________________
Post Srinivasnagar
________________________________
_______________________________
To:
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
To
To:
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
APPLICATION FOR
BY REGISTERED POST
ADMISSION 2013
Ph.D. Programme (December Session)
________________________________
From:
To:
____________________________
____________________________
N.I.T.K., Surathkal
____________________________
Post Srinivasnagar
____________________________
____________________________