MAIDAN GARH|, NEW DELH110 068 APPLICATION FORM FOR OPENMAT-XLII, XLIII ENTRANCE TEST | | © INDIRA GANDHI NATIONAL OPEN UNIVERSITY FORM NO. 1 Hi FORM No.: INSTRUCTIONS 1, Plage reaginenatocion ne inomatinbehre beng pier. 2 Use BLAGKCBALL PONT PEN none ug Ens cntal ates or Englsh nana 3: Donetnae any ray mane ob shes ‘CONTROL NUMBER: 4 Borat stale pn, wl seb aero a hi re 5. te n CABAL LETTERS ony wnt bor wiht auting eines shown Inthe Samp bln (PL 2s Tals Te Tr1e [Tafa [elo[el= [el#1 [Tele T1N [ol [oles [0 eee ee] 1 Restonal 2. Bxamistudy 3. State “Cmegery f2:0\ St ove Gen Cente a Coa Peer 5. Nationality © Sex 7-Marital Status 8. Whether Minority: 9. Religion Wie we ive aseine bon Sitar we ‘wr eon As ints 96 380 GPa cacioakon cas ata ‘sieht Shc, BE a Se an *- ” ‘seme 5 Guana Fe auomit 29 Stu 16. Date of Birth 11, Social Status win mina 12, Whether Keshmiel Migrant Dae Ment Year a 1 aac man Cate niore at oe / / & se esesetos’ Be 18. Tertory 14. Employment Status 15. Whether Physically 153. If physically handicapped Handicapped: (eature of sabi) tS 1 petesngeet Sena SOR sve 82 ctr ate 3 TAIBAL Bees Enmoree Ne 5t Reaseg Baan, B ket Are you registered with 1GNOU 162. tyes, write the Enrol. No. & Program Code In th ‘wie reece ne) EnionentNo 17. Details of Scholarship being received if anjz (9 Dep. Ofeing Wwe meron tebe) Faroe eu (2) Annual Seholarship ‘Scho ss aon Det ‘AY =Below Siac 04=2025 oss cog Sua TEER. 4 Fold trom here> 18. Name ofthe Candidate 1, weriHusband (ste out whihever not anpicabe) 20. (a) Educational Qualifications ofr the programme): Year of Passing Percentage of mares 20.(b) Stream: (Cross (X) any one ofthe Appropriate Box ony) NON-GRADUATE (10%2 oritsequivalen) Science Arls_—=—=Commerce «Engineering Others GRADUATE POST GRADUATE 21. Write Name & Complete Mailing Address For Office Use 24. Photograph (BLACK BALL Pont Pen ony. crv! Ne Nave Afi your atest Adress: passport size Photograph (em 5em) duly 23, Candidate's Signature ‘ATTESTED BY GAZETTED OFFICER PI cove | | Important : Please see ‘Instructions for Candidate’ overleaf. | |25. Working Experience Duration Years Months. Employed in (Cross (X) any one ofthe Approprat Box only) Govt/Publc Sector Put Sector Sel Employed ‘Annual Income (Cross (X) any one of the Approprat Box only) Upto & 100000/- Ft lacto2iac FZlacto 5 lac TSlacto1olac Above % 10 lacs 26. Address for Correspondence (Do not give Post Box No. address. Leave a blank box between each unt of address lke House No., Street Name, P.O, ete) District State Pin Code 27. Telephone Number (if any) with STD Code/Mobile No. 28, Fax No, (any) with STD Code STD Code phone No. STD Code Telephone No. 2, Emall address/ (i ary) DECLARATION BY APPLICANT | hereby declare that | have read and understood the conditions of eligibility for the programme for which | seek admission. | fulfl the minimum eligibility criteria and have provided necessary information in this regard. In the event of any information being found incorrect or misleading, my candidature shall be liable to cancellation by the University at any time and | shall not be entitled to refund of any fee paid by me to the University. | have carefully studied the rules of the University as printed in the Prospectus and I accept them and shall not raise any dispute in future over the same rules, Date: (Signature of the Applicant) INSTRUCTION FOR CANDIDATES 1. _ Forfilling this Form please refer to “Instructions for filing the Application form for Entrance Test (OPENMAT)- FORM-1” in the Student Handbook & Prospectus. 2. Please send your Application form by Registered/Speed Post to the following Address: Registrar Student Evaluation Division IGNOU, MAIDAN GARHI, NEW DELHI-110068 Last date for receipt of filled in application form for OPENMAT XLII and OPENMAT XLIIlisas indicated in the advertisement. Application form received after the due date will ot be accepted, Please retain photo copy ofthe filled application form for future reference No documents are tobe attached with this application form.