BRAINWARE UNIVERSITY a CEE OULU a ae axe Proposed area of work: 1, General information Category: General Cl IRF Passport size photograph of ‘the applicant ‘Name of the Applicant (Gn capital letters) ‘Address for correspondence Landline Number Mobile Number: Email: Permanent Address: Date of Birth (attach a copy for proof of Date of Birth) ‘Married’Single ‘Mother Tongue: ‘Nationality State! Do you belong to Reserved Category? Yes No Iyes, specify. SC Differently Abled Candidates (T] st osc 2, Designation, department and organization (if employed) Please give name and address of the employer and send your application form through your employer along with a No Objection Certificate from the employer, 3. Father's/Husband’'s/Guardian’s name, address and ‘mobile number: In case of guardian, relationship with the applicant:4, Educational Details (from school leaving): - a Year of ee Examination Passed | Jearoe Board/College/University Division % (Class Marks * Please attach copies of certificates and statements of marks in support of the information provided, ** Where grade points are awarded, please indicate equivalent percentage along with the supporting documents. 5. Details of published/presented papers (attach separate sheet, ifrequired) 6. Have you taught any subject in College / University? If yes, please give details. Name of the College / University Subject(s) and course Year(s) 7. Discipline in which you like to work for the Ph.D. degree (State major area and sub-area within it) 8, Have you qualified the UGC NET for JRF lectureship? Yes/No ITYES, please provide the details and attach a photo copy of Certificate9. Any other relevant information which you may like to provide (please use a separate sheet, if necessary). (Thereby declare that the information furnished in this application and in the documents submitted herewith is true, complete and correct to the best of my knowledge and belief I understand that in the event any information is found false, incomplete or incorrect, my application/admission is liable to be rejected / cancelled. (i certify that currently T am not enrolled as a student in any course of studies or registered for the doctorate degree in any University. I undertake not to be enrolled or registered so long as I will remain registered for PhD, degree at Brainware University. (ii) I shall furnish to the University, within 30 days ffom the date of registration, my migration certificate, failing which my registration is liable to be cancelled. (iv) Thave read the rules governing the Ph.D. degree program and I undertake to abide by them. Place: Signature of the Applicant Date: For Office Use Only Recommendation of the Pb.D. Committee: The applicant is eligible for /not eligible for/ exempted from the Entrance examination Chairman Ph.D. Committee in Registrar Date Date