FORM-R2

ANDHRA UNIVERSITY
DIRECTORATE OF ADMISSIONS

ORIGINAL
Registration No.

APPLICATION FORM FOR PART-TIME M.Phil./Ph.D. RESEARCH ADMISSION

Last date for receipt of filled-in applications without fine: 20-06-2013 (5 p.m.);
With late fee of Rs. 1,000/- , 30-06-2013 (5 p.m.)
Note:1: Admission into M.Phil./Ph.D. degree shall be made in accordance with guidelines specified in the
Resarch admission information Brochure. Strike off whichever is not applicable and put a
mark
wherever necessary. Each application should be accompanied by a D.D. of Rs.800/- (Rs.500/- for
SC & ST) drawn in favour of Director, Directorate of Admissions, Andhra University, Visakhapatnam
on any Nationalised Bank, payable at Visakhapatnam.

Affix attested
recent
Passport size
photo

1. Particulars of Registration fee:

Amount: Rs. .............. D.D.No. ......................... Date: .................

Name of the Bank: ...................

2. Department Code &

Name
3. Research Programme for which the candidate wants to be considered:
M.Phil

Ph.D.

4. Name of the Applicant (in Capital Letters):

SURNAME

NAME

5. Name of the Father / Mother:

(Guardian, if parents are not alive)
DATE

6. Sex: Male

Female

8. Residential status:

Local

9. Reservation Category:

SC

MONTH

YEAR

7.Date of Birth:
Non-local
ST

BCA

BCB

Other State
BCC

BCD

BCE

PH

10. Particulars of Qualifying Examination (Attested Xerox Copies of the Marks staments & PC must be enclosed.
Otherwise the application will be Rejected)
Qualifying
P.G./M.Phil.
Degree

Subject studied /
Specialization

11. Permanent Address:

Percentage
of Marks /
CGPA

University

Year of
Passing

12. Residential Address

...................................................................

.................................................................................

...................................................................

.................................................................................

...................................................................

.................................................................................

PIN code: ....................Ph.No. ......................

PIN code: .....................Ph.No. ..................................

Email :.........................................................

Mobile No : ................................................................

13. (a) Name of the research guide in the department. : .........................................................................

(b) Name of the research guide in affiliated college : .........................................................................
if any.
14. Service Particulars:

Service Cum No objection Certificate

This is to certify that ____________________________________________________ has been working
(Name of the Candidate)
as ______________________________ in our institution ________________________________________
(Designation of applicant)

(Name of the institution)

As Permanent / temporary/consolidated/hourly basis employee. The institution does not have any objection
for the candidate to pursue M.Phil. / Ph.D. (Part Time) in Andhra University.
S.No.

Designation

Institution

Length of the Service

1
2
3
4
5

(Signature of the Candidate)

Place:
Date:

(Signature of the Authorized signatory with seal)

Note: Signatory shall be responsible for the veracity of the Certificate.

DECLARATION BY THE CANDIDATE

I here by declare that the particulars given in items 1 to 14 above are correct. In the event of any
information being found false, I declare to forego my admission forthwith.

Date:

Signature of the candidate

FORM-R2

ANDHRA UNIVERSITY
DIRECTORATE OF ADMISSIONS

DUPLICATE
Registration No.

APPLICATION FORM FOR PART-TIME M.Phil./Ph.D. RESEARCH ADMISSION

Last date for receipt of filled-in applications without fine: 20-06-2013 (5 p.m.);
With late fee of Rs. 1,000/- , 30-06-2013 (5 p.m.)
Note:1: Admission into M.Phil./Ph.D. degree shall be made in accordance with guidelines specified in the
Resarch admission information Brochure. Strike off whichever is not applicable and put a
mark
wherever necessary. Each application should be accompanied by a D.D. of Rs.800/- (Rs.500/- for
SC & ST) drawn in favour of Director, Directorate of Admissions, Andhra University, Visakhapatnam
on any Nationalised Bank, payable at Visakhapatnam.

Affix attested recent

Passportsize photo

1. Particulars of Registration fee:

Amount: Rs. ............ D.D.No. ......................... Date: .................

Name of the Bank: ...................

2. Department Code &

Name
3. Research Programme for which the candidate wants to be considered:
M.Phil

Ph.D.

4. Name of the Applicant (in Capital Letters):

SURNAME

NAME

5. Name of the Father / Mother:

(Guardian, if parents are not alive)
DATE

6. Sex: Male
8. Residential status:

Female

Non-local

Local
SC

MONTH

YEAR

7.Date of Birth:

ST

BCA

BCB

Other State
BCC

BCD

BCE

PH

9. Reservation Category:

10. Particulars of Qualifying Examination (Attested Xerox Copies of the Marks staments & PC must be enclosed.
Otherwise the application will be Rejected)
Qualifying
P.G./M.Phil.
Degree

Subject studied /
Specialization

11. Permanent Address:

Percentage
of Marks /
CGPA

University

Year of
Passing

12. Residential Address

...................................................................

.................................................................................

...................................................................

.................................................................................

...................................................................

.................................................................................

PIN code: ....................Ph.No. ......................

PIN code: .....................Ph.No. ..................................

Email :.........................................................

Mobile No : ................................................................

13. (a) Name of the research guide in the department. : .........................................................................

(b) Name of the research guide in affiliated college : .........................................................................
if any.
14. Service Particulars:

Service Cum No objection Certificate

This is to certify that ____________________________________________________ has been working
(Name of the Candidate)
as ______________________________ in our institution ________________________________________
(Designation of applicant)

(Name of the institution)

As Permanent / temporary/consolidated/hourly basis employee. The institution does not have any objection
for the candidate to pursue M.Phil. / Ph.D. (Part Time) in Andhra University.
S.No.

Designation

Institution

Length of the Service

1
2
3
4
5

(Signature of the Candidate)

Place:
Date:

(Signature of the Authorized signatory with seal)

Note: Signatory shall be responsible for the veracity of the Certificate.

DECLARATION BY THE CANDIDATE

I here by declare that the particulars given in items 1 to 14 above are correct. In the event of any
information being found false, I declare to forego my admission forthwith.

Date:

Signature of the candidate

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