Pree Rs 250 FORWCA Na] Gy UNIVERSITY OF RAJASTHAN, JAIPUR ZN PPLICATION FORM FOR M.Phil./Ph.D. ENTRANCE TEST-2010 (Date of Test : July 27, 2010) Facully Name of DepartmentGentre University of Rai/ Name of y ia Sitting Colleae Applying for (tick win box) M.Phit] — [Pn.o.] [Bott 1. Applicant's Name (IBLOCK LETTERS) : 2 (i) Mother's Name SPACE FOR PHOTO (i) Father's Name atlestod by Gazetod 3. Date of Birth 4. Category ffcerUniversty Teacher) (S.C/S.T/0.B.C/GeneraVOthers) (py (my rYYH) (Attach supporting document if not General) 5. Applicant's Address --------~ --.-- Mobile No, -.--- Tel. No. with S.T.D. Code 6._Academic Qualification: (Attach self attested copies) Examination Year University/Board Max. | Marks | Percentage Marks | Obtained | Marks/Grade Postgraduate Under-graduate ‘Senior Secondary ‘Other (Specify) Declaration less knowledge and belief. . hereby declare that the information given above is correct to the best of my Date & Place Signature of Candidate Form No, Roll No, (Tobe filled by office) Faculty & Subject cece eee cece cece eee eee cee ee eeeee eee ceeeeeeneee Name of Candidate Mother's Name SPACE FOR Father's Name PHOTO Address Centre of Examination Date of Examination 27.07.2010 Session-I: 10.30 A.M, -12.30P.M, Session-Il: 1.30 PM. — 4.30 PM, FORM No. Date: Received Application Form-Afrom ww 1 10/10. (Name of Candidate) for UNIRAJ MPAT-2010 with D.D.No. FOF RS. Bank Of Signature of Receipt Clerk with seal of the DepartmentForm No, ADMIT CARD (For Office Use Only) 1. Applicant's Name srrrrenneseessentesseesascessees 2 Mother's Name cece eee cee cece ceeeeneeeeeneeeeee Father's Name ceeeeereeee 3. Date of Birth cece eee cee cece ceeeeneeeeeneeeeee 4, Category (8.C./S.1/0.8.C./General/Others). 5. Applicant's Address cece eee cee cece ceeeeneeeeeneeeeee 6. Centre of Examination Date of Examination Signature of candidate Session! sess pecs tees eens eee eeee eee eee Session-Il ceeeeeeceeeceeeeeceeeeeeeeeeeeeee 27.07.2010 Session- : 10,30 A.M. ~ 12.30 PM. Roll No. - SPACE FOR PHOTO (Passport size photo tested by Gazetod OffcarUniversity Teacher) Session: 1,30 PM, ~ 4.30 PM, Signature of Invigilator Signature of Centre Superintendent with seal Note: Attach a Self-Addressed Envelope (size 23*10 cm) with the application form.