Office Ref.

No

Web : http://www.bsauniv.ac.in Tel:+91 44 22759236 / 22759200 / 22759223, Ext :124 / 223

Email: dean.academicresearch@bsauniv.ac.in

APPLICATION FOR ADMISSION TO Ph.D. PROGRAMME

(Pl. tick the relevant column)
Full Time
Part Time
Full Time with Fellowship
Department of Registration (Pl. refer sl. no. 16) :
(to be filled up by the candidate)

1. Name (in Block Letters) :

Affix a recent
2.a. Date of Birth (DD/MM/YY) : Passport - size
Photograph
2.b. Age :
3. Gender : Male / Female
4. Nationality : Indian / Foreign
5. If Foreign National, : Country :
: Passport No.:
6. Social Status : ST / SC / MBC / BC / OC

7. Id Proof
7.a. Aadhaar No. :
(enclose photo copy of the Aadhaar card)

Aadhaar No. is essential. If Aadhaar number is not available, the number in the photo ID card,
issued by a Government Agency should be furnished in either 7b or 7c or 7d

7.b. Voter ID card :

(enclose photo copy of the Voter ID card)
7.c. Driving License :
(enclose photo copy of the Driving license)
7.d. Pan Card :
(enclose photo copy of the Pan Card)

8. Marital status : Married / Unmarried

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9. Contact details :
Email ID Telephone
Mobile No.
(Official & Personal) (with STD code)
i) Off :
ii) Per:

a) Office Address b) Residential Address

c) Address for communication : Office Residence

10. Type of Registration:

Category Sponsored Not sponsored

Full Time

Part Time

Fellow ship

b) If part time, what category:

i) University staff ii) Other Colleges / Universities

iii) Industry (Govt.) iv) Industry (Pvt.)

v) Research Centre

vi) Others (Pl. specify) …………………………………...

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11. Details of Academic record:

Full Time /
Month
Degree Part Time/ % of
University / &Year
S.No (Pl. Discipline Distance / Marks / Class
College of
specify) Weekend CGPA
passing
(specify)

1. UG

2. PG

3. M.Phil.

4. Others

12. Academic Performance:

(Attach Separate Sheet, if required)

a) Bachelor’s Degree (Pl. specify):…………… Discipline: ………………

Semester I II III IV V VI VII VIII

Percentage of marks
/ CGPA obtained

b) Master’s Degree (Pl. specify):…………… Discipline:……………….

Semester I II III IV V VI
Percentage of marks /
CGPA obtained

c) Additional Qualification (Pl. specify if any) ………………………………..

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13. Professional Experience (Teaching / Research / Industrial)
(Attach Separate Sheet, if required)

Period Regular /
Name of
S.No Designation From To Temporary/
Organization
Contract

Total

14. Details of current employment ( if applicable)

i) Name & address of the employer :

ii) Designation :

iii) Name of employment : Regular / Contract / Part time / Temporary

/ Trainee

iv) Scale of pay :

v) Working since date :

vi) Total years of experience :

15. Details of publications in refereed/peer

reviewed Journal
(Attach Separate Sheet, if required)

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16. Department to which Ph.D programme is applied for (pl. tick the programme)

Civil Mechanical EEE

ECE CSE E&I

IT Polymer Automobile

Computer
Aerospace Economics
Applications

Actuarial
Mathematics Physics
Science
Molecular
Chemistry English
Biology

Biochemistry Microbiology Biotechnology

Business Islamic Banking

Genetics
Management & Finance
Islamic
studies

17. Proposed Major Area for Ph.D.programme :

18. Tentative Research topic (A one page :

write up of the proposed research with
signature of candidate should be enclosed)

19. Particulars of Demand Draft:

Name of the Bank & D.D. No. Date Amount

Branch

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20. List of enclosures :

i) Attested copies of mark sheets / ii) Employer’s certificate (NOC)

Grade cards (U.G & P.G)

iii) Passport size photo (4 Nos) iv) One page write up

vi) Whether DD enclosed vii) Photocopy of Aadhaar card

or other photo id card issued
by a Government agency

vii) Soft copy of Application and viii) Others if any (specify)……………..

scanned copy of documents
to Dean (Academic
Research) by email

DECLARATION

I hereby certify to the best of my knowledge and belief that the particulars given
above are true, correct and complete. I am aware that any wrong information or
suppression of information and facts may result in punitive action in addition to
cancellation of my candidature for Ph. D programme admission.

Signature of Candidate
Place :
Date :

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 Annexure I

CERTIFICATE OF EMPLOYMENT AND NO OBJECTION

1. Certified that Mr / Mrs / Ms. …………………………………………….. is

employed as …………………………………… in the Department of
…………………………… of ……………………….. for the last …………….. Years.

2. While forwarding his / her application, we certify that we have no objection for
him / her pursuing Ph. D. programme in B.S. Abdur Rahman Crescent Institute of
Science & Tehnology.

3. As the applicant will be pursuing, Ph.D programme on Full Time basis, we will
sanction leave for the duration of the research programme and will be relieved from his /
her duties to undertake the research work.

4. As the applicant will be pursuing Ph.D programme on Part time basis, he / she
will be allowed to be present for discussions with the supervisor, attending course work,
conduct experiments and participation in seminars and all related discussions. Further
we will provide the required facilities at our Institution / Organization to the applicant for
doing research.

( NB : Strike out para 3 or 4, whichever is not applicable)

Signature of the Head of the

Organization with office seal

Place :

Date :

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