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BHAGWANT UNIVERSITY, AJMER
BURET
-
2018
Application Form
(Date of Examination: Sunday, 12
th
Aug, 2018)
Form No.
________________________
Registration No.
_________________________
(For office Use)
(For office Use)
Program applied for:
M.Phil
Ph.D.
Department:........................................
(Please fill in the Application Form in BLOCK LETTERS)
Name (Mr./Mrs./Ms.)
_________________ _________________ ______________
Surname
First Name
Middle Name
Father’s Name
_________________
_________________ _________________
Recent Passport
Size Photograph
Surname
First Name
Middle Name
Mother’s Name
_________________ _________________ _________________
Surname
First Name
Middle Name
Date of Birth
Nationality
_________________
Date
Month
Year
Religion
_________________
Caste Category
: SC/ ST/ OBC/ General
Address:
___________________________________________________________________________
____________________________________________________
Pin
Landline________________ _____ _________Mobile_______________________________________
Office:
_____
__________________________________________________________________________
____________________________________________________ Pin
Landline______________________________ Mobile_______________________________________
Email ID ______
______________________
Aadhar No. ____________________________________
Marital Status:
Single
Married
Gender:
Male
Female
Hostel Facility Required:
Yes
No
Educational Qualifications:
Examination
Institution
Board/University
%
Year
Subject
Secondary
10+2
Graduation
Post graduation
Any other
qualification
1
Extra
-
curricular activities and honors received (if any)__________________________________
______________________________________________________________________________________
Entrance Fee Paid Details: Rs. 1000 paid vide ..............................................................
DECLARATION BY CANDIDATE
I,
Mr./Mrs./Ms._________________________________________________________
hereby
declare
that
the information furnished in this form is true to the best of my knowledge and belief. I am submitti
ng this
application, with the understanding that I am eligible for M.Phil/ Ph.D. admission as per UGC norms.
If
later, I am not found
eligible as per UGC norms, my candidature may be cancelled/ terminated by Bhagwant
University Ajmer.
Date:____________________
Signature of Applicant
Kindly forward the duly filled application form along with the DD of Rs. 10
00/
-
in favor of 'BHAGWANT
UNIVERSITY' payable at Ajmer, by speed post/courier/personal visit on the address given below:
(Latest
by Saturday, 4
th
August, 2018)
Bhagwant University
Sikar Road,
Ajmer (Rajasthan)
-
305004
Mob.
-
+91
-
9928144443/ 6376916601
2