MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY

BHOPAL 462003 (M.P.) INDIA

(Deemed University)
Application form for Admission Ph.D. Programmes

Please read the instructions given in the information brochure & on the website [Link] before
you fill up the form, Tick () the relevant box wherever provided. Attach attested copies of
certificates/marksheet in support of following information.
Tick() the relevant box wherever provided

For office use only
Sch. No. : _________________ Name of Branch ______________________Date___________



Full Time
Part Time
Sponsored
Self Supporting
Branch/Subject :
At Graduation : _____________________
At post Graduation : _________________

Department/Center: Applied for : _________________________________________________________

Proposed Research Area (Broad Area) _________________________________________________
(Enclose Brief description of proposed work _____________________________________________
In 500 words on a separate sheet)

P
E
R
S
O
N
A
L

Name(in capital)

Gender/D.O.B. Male Female Date of Birth (dd/mm/yyyy)
Fathers Name
Mothers Name
Address for
correspondence


PIN
Email Id :
Telephone No. with STD Code : Mob.:
Permanent
Address




PIN
Email :
Telephone No. with STD Code : Mob.:

Category to which you belong Gen SC ST OBC PH

P
A
Y
M
E
N
T

Attach I-Collect receipt of Rs. 800/- for General /OBC candidates and
Rs.400/- for SC/ST candidates
For official use
Payment Details
SBI I-Collect No. Amount Rs. Date:
I-Collect received
Reg. No.
Sign.
Photograph
MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY
BHOPAL 462003 (M.P.) INDIA
(Deemed University)
Application form for Admission in [Link]./MUDP
Please read the instructions given in the information brochure before you fill up the form
Tick() the relevant box wherever provided

COURSE APPLIED FOR :
(separate application along with IPO/Demand Draft should be submitted for each course)

1. GATE :
Score :
Year : ..
Discipline : ..
2. Aggregate % of
final year marks(7
th

& 8
th
sem.)
Total %
Theory%
[Link]
(SC/ST/OBC
/ PH/GEN.)

4. Gate
Non Gate

Sponsored:
5. Payment details :
IPO/DD No. :
Drawn on :.
Amount Rs.:..
Date : .
O
F
F
I
C
I
A
L

U
S
E

[Link]. .. Class Roll No. Branch :.. Date of Admission
TO BE FILLED BY THE CANDIDATE
1.
a Name(in capital)

b Address for
correspondence


Email Id : Telephone /Mobile No
c Permanent
Address




Telephone /Mobile No.
d
Date of Birth
In figures (In Christian era) In Words
e
Place of Birth

f
Marital Status
Single Married
g
Category
Gen./SC/ST/OBC/Disabled Blood Group:
h
Religion

i
Fathers Name

j
Mothers Name

k
Occupation of
father/guardian &
Address


Contact Phone /Mobile No.
2.
a Branch at U.G. Level
b Percent of marks in the qualifying Exam
(B.E./[Link]./[Link]./[Link]./[Link].

c Final year marks (i.e. in last two
semesters/last Year only.)
(a) Total %
(b) Only theory %
d Details of GATE Examination : (a) Year of passing .
(b) Discipline of GATE
(c) Percentile ..
Photograph
MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY
BHOPAL 462003 (M.P.) INDIA
(Deemed University)
Application form for Admission in [Link]./MUDP
Please read the instructions given in the information brochure before you fill up the form
Tick() the relevant box wherever provided

COURSE APPLIED FOR :
(separate application along with IPO/Demand Draft should be submitted for each course)

1. GATE :
Score :
Year : ..
Discipline : ..
2. Aggregate % of
final year marks(7
th

& 8
th
sem.)
Total %
Theory%
[Link]
(SC/ST/OBC
/ PH/GEN.)

4. Gate
Non Gate

Sponsored:
5. Payment details :
IPO/DD No. :
Drawn on :.
Amount Rs.:..
Date : .
O
F
F
I
C
I
A
L

U
S
E

[Link]. .. Class Roll No. Branch :.. Date of Admission
TO BE FILLED BY THE CANDIDATE
1.
a Name(in capital)

b Address for
correspondence


Email Id : Telephone /Mobile No
c Permanent
Address




Telephone /Mobile No.
d
Date of Birth
In figures (In Christian era) In Words
e
Place of Birth

f
Marital Status
Single Married
g
Category
Gen./SC/ST/OBC/Disabled Blood Group:
h
Religion

i
Fathers Name

j
Mothers Name

k
Occupation of
father/guardian &
Address


Contact Phone /Mobile No.
2.
a Branch at U.G. Level
b Percent of marks in the qualifying Exam
(B.E./[Link]./[Link]./[Link]./[Link].

c Final year marks (i.e. in last two
semesters/last Year only.)
(a) Total %
(b) Only theory %
d Details of GATE Examination : (a) Year of passing .
(b) Discipline of GATE
(c) Percentile ..
Photograph
MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY
BHOPAL 462003 (M.P.) INDIA
(Deemed University)
Application form for Admission in [Link]./MUDP
Please read the instructions given in the information brochure before you fill up the form
Tick() the relevant box wherever provided

COURSE APPLIED FOR :
(separate application along with IPO/Demand Draft should be submitted for each course)

1. GATE :
Score :
Year : ..
Discipline : ..
2. Aggregate % of
final year marks(7
th

& 8
th
sem.)
Total %
Theory%
[Link]
(SC/ST/OBC
/ PH/GEN.)

4. Gate
Non Gate

Sponsored:
5. Payment details :
IPO/DD No. :
Drawn on :.
Amount Rs.:..
Date : .
O
F
F
I
C
I
A
L

U
S
E

[Link]. .. Class Roll No. Branch :.. Date of Admission
TO BE FILLED BY THE CANDIDATE
1.
a Name(in capital)

b Address for
correspondence


Email Id : Telephone /Mobile No
c Permanent
Address




Telephone /Mobile No.
d
Date of Birth
In figures (In Christian era) In Words
e
Place of Birth

f
Marital Status
Single Married
g
Category
Gen./SC/ST/OBC/Disabled Blood Group:
h
Religion

i
Fathers Name

j
Mothers Name

k
Occupation of
father/guardian &
Address


Contact Phone /Mobile No.
2.
a Branch at U.G. Level
b Percent of marks in the qualifying Exam
(B.E./[Link]./[Link]./[Link]./[Link].

c Final year marks (i.e. in last two
semesters/last Year only.)
(a) Total %
(b) Only theory %
d Details of GATE Examination : (a) Year of passing .
(b) Discipline of GATE
(c) Percentile ..
Photograph
MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY
BHOPAL 462003 (M.P.) INDIA
(Deemed University)
Application form for Admission in [Link]./MUDP
Please read the instructions given in the information brochure before you fill up the form
Tick() the relevant box wherever provided

COURSE APPLIED FOR :
(separate application along with IPO/Demand Draft should be submitted for each course)

1. GATE :
Score :
Year : ..
Discipline : ..
2. Aggregate % of
final year marks(7
th

& 8
th
sem.)
Total %
Theory%
[Link]
(SC/ST/OBC
/ PH/GEN.)

4. Gate
Non Gate

Sponsored:
5. Payment details :
IPO/DD No. :
Drawn on :.
Amount Rs.:..
Date : .
O
F
F
I
C
I
A
L

U
S
E

[Link]. .. Class Roll No. Branch :.. Date of Admission
TO BE FILLED BY THE CANDIDATE
1.
a Name(in capital)

b Address for
correspondence


Email Id : Telephone /Mobile No
c Permanent
Address




Telephone /Mobile No.
d
Date of Birth
In figures (In Christian era) In Words
e
Place of Birth

f
Marital Status
Single Married
g
Category
Gen./SC/ST/OBC/Disabled Blood Group:
h
Religion

i
Fathers Name

j
Mothers Name

k
Occupation of
father/guardian &
Address


Contact Phone /Mobile No.
2.
a Branch at U.G. Level
b Percent of marks in the qualifying Exam
(B.E./[Link]./[Link]./[Link]./[Link].

c Final year marks (i.e. in last two
semesters/last Year only.)
(a) Total %
(b) Only theory %
d Details of GATE Examination : (a) Year of passing .
(b) Discipline of GATE
(c) Percentile ..
Photograph



Q
U
A
L
I
F
Y
I
N
G

D
E
G
R
E
E

Qualifying Exam ___________________________________________(Attach copy of degree)
Discipline ______________________________ Duration of the course (Years)
______________
Name of University/Institute ________________________________ Year of Passing
_________

CGPA/Marks obtained in
qualifying degree
(MBA/[Link]./MCA/[Link]./
[Link]. etc.)

_______________________

Marks
Obtained
Max.
Marks
Aggregate %/CGPA (Mention
Point scale also)









GATE/NET or any other
equivalent exam passed
Name of
Exam.
Year of
passing
Marks obtained (attached
certificates)

Details of Marks secured in the Examinations other than qualifying examination
P
R
E
V
.

A
c
a
d
.

R
e
c
.

Exam/Degree Specilisation Institute/
University
Year of Passing % Marks/ CGPA
10+2/Equivalent
[Link].
[Link].
Any other

E
x
p
.

I
f

A
n
y

Experience (From date to date) Designation Organization





Have you ever studied and discontinued you studies at NIT Bhopal ______________________________
(If yes, give particulars of the programme earlier attended and the reason for discontinuation)

Names and addresses of two referees who are familiar with your academic background.

Name Name
Address Address


PIN Email PIN Email
Declaration

a] I declare that all the information given by me in this application form is correct to the best of my
knowledge and belief, and I understand that false or incomplete information would cause
invalidation of the application.
b) I shall abide by the decision of Maulana Azad National Institute of Technology, Bhopal in all
matters pertaining to admissions. The decision of the institute shall be final and binding on me.
c) I shall abide by the rules and regulations of the Institute.
d) For all legal actions, suits and proceedings, the jurisdiction of court of law shall be deemed to lie
exclusive at Bhopal.
e) I understand the contents of this form and, particularly, this declaration being made here.
f) I shall abide by the rules & Regulation as per Ph.D. advertisement and subsequent notification if
any.

UNDERTAKING

I, _____________________________ S/o/ D/o _______________________________ State that I am
aware that ragging in any form is banned in MANIT, Bhopal and do hereby undertake not to indulge in
any form of ragging the course of my study at MANIT, Bhopal

Signature of the Candidate
Date : __________________
I am aware that ragging in any form is banned in MANIT, Bhopal and that I agree to abide by the
punishment meted out to my ward in case he/she is found guilty of ragging.
Signature of parent/Guardian
Date: __________________
If candidate is employed, Certificate from the employer is required as per the format
below:

1. Name of the Employing : __________________________________
Organsation

2. Type of Organisation : Central Government State Government
Government Autonomous Organization
Public Sector Enterprise Private Sector Industry

3. Address of Administrative : __________________________________________
Officer/HR Manager __________________________________________
Phone : ______________Fax:__________________
Email : _____________________Mob.____________

4. Designation of the employee : __________________________________________
Seeking admission in MANIT

5. Employment Details :
a) First joined on (date) : __________________________________________

b) Holding the present : __________________________________________
Position since (date)
c) Nature of Job : __________________________________________
(R & D, Design, Production, Marketing, Administrative, Teaching)
Certified that, Mr./Ms.________________________________________________________ employed as
________________________ in this organization is sponsored for admission to Full Time/Part Time
Ph.D. programme of MANIT, Bhopal. He/ She has been employed in this organization for the
past_______ years in a regular cadre. If selected as a sponsored candidate the organization has no
objection to his/her undergoing Ph.D. program at MANIT, Bhopal



__________________________
____________________________

Signature of Applicant Signature of Competent Authority

Name, Designation



FOR OFFICE USE
The candidate may be provisionally admitted / not admitted subject to the following :
i) Production of attested copies of the qualifying degree certificate and marks sheet showing
the required % of marks/CGPA by _______________________
ii) Production of proof from the University/ Head of the Institution of having appeared / passed in
the qualifying degree examination by _______________________
iii) Production of relieving certificate sponsorship from Employer by ______________________
iv) Production SC/ST certificate by ________________________________________________
v) Production of sponsorship certificate ____________________________________________
vi) __________________________________________________________________________


Signature of AR (Admission)