Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Regn. No.
(for Office Use Only)
Note: 1. Write Not Applicable if necessary, Dont leave any column blank. Cutting / overwriting is not allowed. 2. Provisional Registration Form should be duly typed. Manually filled Provisional Registration Form will not be accepted.
Application Id Number Name (in Bold Capital Letters): Date of Birth Fathers Name (in Bold Capital Letters): Mothers Name (in Bold Capital Letters): Stream: (Engg./Mgt./Pharm./App.Sci. etc.) Discipline: Area of proposed research work: Topic of Thesis (tentative topic to be
mentioned, for sub allotment)
Date of submission of this application: Date of declaration of result for eligibility for registration: (Valid for 2 yrs.) Internal / External Candidate: Address of the present employer: Present Address for Correspondence:
14. Telephone No. Permanent Home Address: 15. 16. 17. 18. 19. 20. Telephone No. E-mail I.D. Name, Designation, Field & Address of the Supervisor:
(Attach Certificate from Supervisor)
Deptt. of Univ./approved centre, where research work to be carried: Collaboration with any other Institute
21. ACADEMIC RECORD: The details of all the examinations starting with graduation. Sr. Pass-out Examination Institution / University No. Year
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Subject(s)
%age of marks
Note: Self attested copies of documents must be attached with the application form.
Published Work 22. If yes, the details including the title, the 23. 24. 25. Academic Awards / Distinctions
(Separate sheet may be attached) authors, journal/publisher, year of publication be given on a separate sheet
YES/NO
Teaching Experience
(Separate Sheet may be attached)
How long have you been working on this research problem? Migration Certificate* 26. Attached / Not Attached Amount: 27. Details of Registration Fee University Receipt No.: Date:
* If the applicant is not registered with PTU, a Migration Certificate from the previous University must be attached.
DECLARATION BY THE CANDIDATE: I hereby declare that: a) The information given above is correct and nothing has been concealed thereof. b) I am neither registered/working/studying for another degree nor shall I do so during the entire registration period. c) I have read the Ph.D. Regulations of this University and hereby agree to abide by them. d) I assure all the dues will be deposited in time with the University and a photo copy of receipt will be submitted in the office of Dean (Research, Innovation and Consultancy). Place: Date: Place: Date: Signature of Head of Institute (with seal) where working Signature of the Candidate
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Recommendations of the Supervisor(s): I/We agree to guide in the area of research as mentioned above.
A. Guide
S/o
1 2 3 4 5
Name (with Supervisor ID) Designation Address Telephone No. E-Mail I.D.
Date: Signature of Supervisor B. Co-Guide (if any) 1 2 3 4 5 Name Designation Address Telephone No. E-Mail I.D.
Date: Signature of Co-Supervisor Justification for having Co-Supervisor for research work guidance: (to be provided by supervisor)
Signature of Supervisor List of Documents to be Attached with Registration Form (Check List )
(i) Registration Fee Slip. (ii) Self-attested copy of Result of eligibility for enrolment. (iii) Certificate from Guide and that from Co-Guide (if any). (iv) Original Migration Certificate. (v) Self-attested copies of academic certificates. (vi) Self-attested copy of experience certificate(s). (vii) List of Publications (if any). (viii) Self-attested copies of Academic Awards / Distinction. (if any) (ix) Annexure-A
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