AUg

MANGALORE
20

- 20

zAi
UNIVERSITY

vPvg z PtP z Cf

APPLICATION FORM FOR ADMISSION TO POST- GRADUATE PROGRAMMES FOR THE YEAR 20 - 20
1.

CzsAi Aiz g
DzvUg z

sav
E CAn

2.
3.
4.
5.
6.
7.
8.

Name of the Course with

Subject in the order to preference

Photo to be
affixed here

2.

CsyAi g
:
Name of the Applicant (in Block Letters)

3.

Cv jPAi CzsAi irz LaP AiU, sU, w Aiz qz CAPU

(g U CAP nU AiA itv wU Uw)
Optional Subjects and languages offered at the qualifying examination and marks obtained in
each subject (enclose self-attested copies of mark cards of all the three years).
Marks
Obtained

Max.
Marks

Marks
Obtained

Max.
Marks

Marks
Obtained

Max.
Marks

Marks
Obtained

I
Sem

I
Sem

I1
Sem

II
Sem

III
Sem

III
Sem

IV
Sem

IV
Sem

V
Sem

V
Sem

VI
Sem

VI
Sem

Max.
Marks

Max.
Marks

Total

Marks
Obtained

III Year

Max.
Marks

II Year

Marks
Obtained

I Year
Max.
Marks

Optional

Marks
Obtained

1.

Grand Total
Language
1.
2.

4.

F PPAq Aiiz Uz qAigzg AAzsl PA aAi .

If you are claiming seat under any of the Categories please mark in the appropriate column.
U Category
j ew
SC

5.

j U
ST

Evg Azz U
I

IIa

IIb

IIIa

IIIb

F PPAq Aiiz Uz qAigzg AAzsl PA aAi .

If you are claiming seat under any of the following categories mark in the appropriate column.
Aig Cx
CAUPg
Qq
J... J.J.J.
zgz
vgz
PlP
Persons
Sports
N.C.C.
N.S.S.
Pg U/U
with
Hyderabad
Disability
Karnataka
Son/Daughter of Defence
Quota
Service/ Ex-Serviceman
Z : P.A. 4 v 5 g Aiiz Uz Aizzg P
PjAz qz it vz wAi UwP.
Note : If you are claiming seat under the categories mentioned vide Sl. No. 4 & 5 enclose
relevant copies of the certificate issued by the Competent Authorities.

6.

: v gP
Address: For Communication

:
:

Tel:

Mobile:

7.

gAiv
Nationality

8.

AU
Gender

: UA /
: Male / Female

9.

Csy nAz PlPzg ? :

Cx PlPzg ?
Do you belong to Karnataka by
Birth or Domicile?

10.

vAz/Pg*/UAq g
v
Name and address of Father/
Guardian*/Husband

C) vAi g
Name of Mother

11.

vAz v vAi/Pg*/UAq GzU

v P DzAi J UAz
Occupation of Parent/Guardian*/Husband
and Annual income from all sources

12.

CzsAi irg Pt A :
zAi
Name of the Institution studied

:
:

University

13.

CfAi wz g
(AP Z/rr Uw)
Details of application fees remitted
(enclose the Bank challan/DD)

* vAz Cx v fAvVgz
If parents are not alive

E-mail:

AP Z/rr AS
Bank Challan/DD No.

AP
Date

v
Amount

Wu
CfAi rz P v Czg UvU MzVVg iwU dV
JAz it PV zrPjv. MzVg iwU P gU
Vgz PAq Azg CgP P PP MUUv v AAi U
qVg gzrUzAz Cjwz.
DECLARATION
I hereby solemnly and sincerely affirm that the statement made and information furnished
in my application form as also in all enclosures therewith submitted by me are true. Should it,
however be found that any information furnished is found to be false, I realise that I am liable to
criminal prosecution and that my admission to the course shall be forfeited.

CsyAi gd
Signature of the Candidate

Date:
Pbj GAiUP iv
FOR OFFICE USE ONLY
1.

AAv Aiz qz CAPU

Marks obtained in cognate subject/s

2.

U Cv nAig PAS Pg zyU _____________

Uz qVz JAz F P zrPjVz.
Certified that as per the consolidated merit list Nothe candidate is admitted
under.. Category.

Uj CAPU
Max. Marks

qz CAPU
Marks Obtained

Pq
Percentage

CzsPg, DAi w
Chairman, Selection Committee

CsyUU Z
INSTRUCTIONS TO CANDIDATES
1.

sw irz CfU AAzsl vPvg sUz CzsPg/AAidPg, AUg

zAi, AUUAUw/svPvg CzsAi PAz, aP Cg, EjU P
PqP.
The Application forms duly filled should be sent to the Chairman/Co-ordinator of the
concerned Department, Mangalore University, Mangalagangothri/P G Centre Chikka
Aluvara.

2.

CfAi x Dzv z sUP vPz,

The Original application shall be submitted to the department of first preference.

3.

zyAi MAzQAv Z PU Cf Eaz CfAi egP w

U Uv wz Z, CAPn v ew/DzAi it vz w v
AAzsl sUP vPz.
If the candidate is applying for more than one course, the xerox copy of the original
application along with the copies of the challan, Marks card and cast / Income certificate
should be submitted to the respective departments.

4.

PAi APz CAvg Az CfU jUtU.

Applications received after the due date will not be considered.

5.

v: itPv PU iv CfU UwP. z Ai U

MzVP.
Self-attested copies of the required certificates/marks cards should be attached to the
application. Originals should be produced at the time of admission.

6.

PtP g Aiz dgrU CAP nU v it vU D

Ptz C VAigU AwgVUAz CsyU UvPz.
Candidates seeking admission to a course should note that their original marks card and
other certificates produced at the time of admission to the course will not be returned
until they complete the course.

7.

Ct Cx v iwAi v iqz Eg CfAi wgjUz.

Unsigned / incomplete / wrongly filled-in applications are liable to be rejected.

*********