MADURAI KAMARAJ UNIVERSITY

EVENING COLLEGE
Alagarkoil Road, Madurai – 625 002

M.Phil Programme
2019-2020

Application No:

Subject Applied For

Applicant’s
Photograph
Availability of M.Phil Entrance Eligibility Certificate/UGC NET/TNSET/CSIR NET: Yes / No 
Photograph must be
1. Name of the Applicant In English____________________________
signed by the
candidate ( at the top)
(IN BLOCK LETTERS) and Attested by a
In Tamil _____________________________ Gazetted Officer (at
the bottom)

2. Gender: Male/Female 3. Date of Birth and Age:

(Christian Era)

4. Place of Birth, District and State:

5. Nationality and Religion: 6. Aadhar Number:

7. Mother Tongue: 8. Blood Group:

9. Community OC/BC/BC (Muslim) /MBC/DNC/SC/SCA/ST

(Enclose attested copy of the community certificate)

10. a) Name of the Father / Guardian: Cell No:

b) Name of the Mother / Guardian: Cell No:
c) Occupation of the Parent /Guardian:
d) Annual Income of the Parent /Guardian:

   
Permanent Address Address for Communication

Phone: Phone:

11. Email id: Cell / WhatsApp Number:

12. Educational Qualification ( since SSLC) Strike out those not applicable
Sl. Course / Certificate Subject Institution / Board Year of %
No. Passing Marks/
Grade
1 SSLC
2 HSC
3 BA/B.Sc./BBA/B.Com
4 MA/M.Sc./MBA/M.Com
5 M.Phil Eligibility Certificate

Office Seal:
Signature of the Attesting Officer
Name :
Designation :

13. Enclose Photo Copies of the following:

a. All Educational Qualification Certificates with their respective Mark Statements
b. Transfer Certificate c. Community certificate
Also enclose: One self addressed stamped Envelope of size 28 cm x 13 cm for Rs.10 and Three Passport size Photos.

Note: i) DO NOT SEND The Original certificates ii) Application without required enclosures will not be entertained.

DECLARATION OF THE CANDIDATE

I do hereby declare that the particulars furnished in the application are correct and true and
that I shall abide by the rules and regulations of the College.

Date: Signature of the Applicant

   
 FOR OFFICE USE ONLY

The following originals are verified

1. Transfer Certificate 2. Community Certificate

3. SSLC Mark sheet 4. HSC Mark sheet
5. UG Degree Certificate 6. PG Degree Certificate
7. PG Mark Sheet 8. M.Phil Eligibility Certificate

All Original Certificates are returned to the candidate except TC

Name and signature of the verifying officer

Name and signature of the Candidate

Director (i/c)