Form No.

M001

INSTITUTE OF CHEMICAL TECHNOLOGY

[UNIVERSITY UNDER SECTION 3 OF UGC ACT (1956)]
MATUNGA, MUMBAI – 400 019.

FORM OF APPLICATION FOR REGISTRATION AS A

POST GRADUATE STUDENT
(BY RESEARCH/PARTLY BY PAPER AND PARTLY BY RESEARCH)

Reg.No.------------------

Date: ---------------------

To,
The Registrar,
Institute of Chemical Technology,
(Deemed University us/3 of UGC Act 1956)
Mumbai - 400 019.

Sir,
I request that my name be registered as a post-graduate student for the ____________Degree
in ________________________________________ of the Institute of Chemical Technology.

I have not passed the examination for the said degree in the same subject of this or of any of
the University nor I have registered as a student for any other Degree or Diploma Course for
any other branch of the said Degree Course.

The registration fee of Rs.___________________ is paid viva D.D./ Money order

_______________dated _______________drawn on .

Yours faithfully

(Students Signature)
_________________________________________________________________________
I. PERSONAL DETAIL
(a) Name in full in CAPTIAL LETTERS ___________________________________
(Beginning with surname)

(b) Address (Local) with residence _______________________________________

Telephone number if any } _______________________________________
E mail ID:

(c) Race and Religion _______________________, Male or Female _____________

(d) Nationality ________________________________________________________

(e)
Examination Month & year of Class University Optional
State the passed passing Subject
qualification on
which student has
registered for the
said course

Particular of provisional statement Eligibility No. of Date Name of the

of eligibility issued by this Provisional of course for
University (this applied to the State of issue which issued
students who are seeking registration eligibility
on the basis of qualification/s
obtained in other University.)

1
Additional Qualifications if any: ________________________________________________

The full title of the problem of research: __________________________________________

__________________________________________

____________________________________________________________________________

N.B. (1) No Student will be allowed to appear for a post-graduate examination unless he has taken the qualifying
Bachelor’s or Master’s degree as the case may be.
(2) Person who hold qualifying degrees of other Universities have to obtain a provisional Statement of
eligibility from this University before applying for registration as post- graduate student.
(3) The registration fee must accompany the form.

CERTIFICATE TO BE ISSUED BY THE TEACHER UNDER WHOM STUDENT HAS

REGISTERED FOR THE MASTER DEGREE BY RESEARCH.

I certify that Shri/Smt./Kum.___________________________________________________

propose to work under me and he/she is not related to me and at present (including ) total No.
________ students registered under me are -----viz. Master degree by research ___________
and Ph.D. __________ .

Telephone No. Residence : ________________ Email ID __________________

Office : ________________

Residence Address : _________________________________________________________

____________________________________________________________________________

Place :

Date :
Name and Signature of the teacher
Under whom the student has worked.

Name of the Guiding Teacher ____________________

Information to be signed by the Head of the Department

I certify that the information given by the student and guiding teacher are correct as per my
knowledge and belief.

Place :
______________________
Date : Signature
Note :- At the time of submission of registration form the following documents are required to be attached :
1. Registration from duly completed by the student and the Department in all respects.
2. Certified zerox copy of the Statement of marks.
3. Certified zerox copy of the Degree Certificate.
4. Certified zerox copy of the provisional statement of Elilgibility (if the student is from another University)
5. Certified zerox copy of the Marriage certificate. (In case of female student)
6. In the case of foreign students certified copy of the passport, student visa, research visa, NOC from
concerned Police and Government authorities.

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