Form No. Ph.D/2015-2016/ (Last date for submission of application 29/06/2015) Form fee Rs. 750/- KADI SARVA VISHWAVIDYALAYA SECTOR-15, GANDHINAGAR-382015 Application for Ph.D 252 / M.Phil 100 (To be submitted by the candidate for appearing the Entrance Test / Claiming exemption from Entrance Test) Form submitted on: / /2015 (for office use) Affix Recent Form submitted for: Ph.D in photograph Form submitted for: M.Phil in Demand Draft No. Date: (Demand draft be drawn in favor of Kadi Sarva Vishwavidyalaya payable at Gandhinagar) 1. Name of the candidate: (As mentioned in qualifying examination certificate) 2. Father/Husband’s Name: 3. Address for Communication: Email: Phone: Mobile: 4. Date of Birth: 5. Category/Caste: Open SC ST OBC (Attach caste certificate if belonging to reserved category) Page | 1 Form No. Ph.D/2015-2016/ 6. Educational Qualification (HSCE onwards) (Attach testimonials) University/ Year of Class/ % of Degree Board Passing Division marks Major subject(s) H.S.C Bachelor of Master of Other 7. Employment details: (Attached separate sheet if required) Sr. No. Name of employer with address Designation/ Post held Nature of duties From To 8. Details of research experience if any: (Attach separate sheet if required) 9. Details of Publications, Patents etc. (if any): (Attach separate sheet if required) 10. Exemption from Entrance Test required: Yes / If required: (a) Mention valid reason for seeking exemption. No (b) Attach authenticated copy of certificate/document in support of exemption claim. 11. Proposed Title of Research: (Research Proposal must be attached) Date: Signature of the candidate Page | 2 Form No. Ph.D/2015-2016/ TO BE FILLED BY EMPLOYER (applicable to employed applicants) This institution has no objection if Mr./Ms. pursues the research work proposed in this application for the award of Ph.D Degree by Kadi Sarva Vishwavidyalaya. This is further to assure that all the local facilities will be extended to the candidate. Name, Address & Email-ID of the Institute: Contact person: His/Her Contact No. & Email-ID Date: Office seal Signature of authorized signatory of the Institute DECLARATION BY THE CANDIDATE I hereby declare that the information submitted in this application is correct to be best of my knowledge and belief. I am well aware that my candidature will stand disqualified if and when any of the information submitted by me is found false. I further declare and undertake that I shall follow all the rules and regulations in force at the University from time to time. Date: Place: Signature of the candidate Page | 3
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