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(d) E-mail:
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ACKNOWLEDGEMENT
Sl. No.
Submitted the application form:
No. ...................... Dated ................................ with necessary enclosures (Xerox Copies)
1. S.S.L.C. & P.U.C. Marks Cards: ............................. 2. Caste Certificate: .................................
3. Foreigner quota....................................
Verified and Checked: ............................................ Signature of the Verifying Authority
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8. Institution last studied Institution:
Date of Admission:
Date of completion of PUC / 10+2:
9. Name, occupation and total Annual Income Name of Father / Mother / Guardian:
of Parents/ Guardian (If parents not alive) Occupation:
Annual income:
10. (a) Postal Address:
(address for correspondence)
Entrance Exam Fee: D.D No. With Name of the Bank: __________________________ Date: __________
DECLARATION
(1) I submit this application seeking admission to 5-Year Integrated M.Sc. Molecular Biology Course (10
Semesters). I declare that I have read the rules and regulations in this regard.
(2) I hereby solemnly and sincerely affirm that the statement made and information furnished in my application
form and also in the enclosures submitted by me are true. Should it however, be found that any information
furnished therein is untrue in material/particulars, I realize that I am liable to criminal prosecution and the
seat given to me shall be liable to be forfeited.
Place :
Date Signature of Applicant