Application No.

SIR PADAMPAT SINGHANIA UNIVERSITY

Udaipur
APPLICATION FOR Ph.D DEGREE ADMISSION FOR
SCHOOL OF ENGINEERING/ SCHOOL OF MANAGEMENT
ACADEMIC SESSION: 2012-13
Section A: Discipline

_____________________________________

Section B: Personal Detail

Candidates Name:
(in block letters)

____________________________________

Date of Birth (DD/MM/YYYY)

____________________________________

Gender:

Male

Category:

Gen

Female
SC

ST

OBC

Nationality:

__________________

Locality

Urban/ Rural

Fathers Name:

_______________________________________

Fathers Contact No. Phone:

__________________ Mobile _______________

E-mail ID:

_______________________________________

Mothers Name:

_______________________________________

Section C: Contact Details

Permanent Address:

______________________________________________
______________________________________________
City _____________________State_________________
Country __________________ Pin Code _____________

Correspondence Address:

______________________________________________
______________________________________________
City _____________________State_________________
Country __________________ Pin Code _____________

Telephone No:

________________ Mobile No._____________________

E-mail ID

______________________________________________

Local Guardians Name:

_____________________________________________

Relation with Student:

_____________________________________________

Address:

______________________________________________
______________________________________________
City _____________________State_________________
Country __________________ Pin Code _____________

Telephone No.

____________________ Mobile No. _________________

Please paste your

latest passport size
colour photograph
(3 cmX4 cm)

Section D: Qualifications
Exam
Passed
th
10
Standard

Year

Board/Unive
rsity

Subjects

Marks
obtained

Percentage

th

12
Standard

Bachelor
Degree

Masters
Degree

Any other

Section E: Publications (Enclose the list of publications, if any)

Section F: Work Experience (If Any)*
Organization

Designation

Nature of Work

Date(s) of
Employment

* May use separate page, if required.

Section G: Whether Qualified in CSIR/UGC NET/SLET/GATE
If yes, give details
___________________________________________________________________________
___________________________________________________________________________
Section H: Application Fees

Bankers Cheque/Bank Draft No. _______________ for Rs. _________________ Dated __________

Bank Name:_______________________________ Branch ________________________________.

Note:
Application form must be accompanied by a Bankers Cheque/demand draft of Rs. 1000/- favouring Sir
Padampat Singhania University payable at Udaipur, Rajasthan. Write the name & address on the reverse
of the Bankers Cheque/Demand draft.
Section I: Declaration
I certify that I have read this application and instruction and that to the best of my knowledge, the information
given are true and correct, and if any of it is found to be incorrect, my application will be invalid and my
admission shall be cancelled.
In the event of my selection and admission to the University, I will abide by the rules and regulations of the
University. Incase of violation of any rules and regulations by me, I shall be liable to disciplinary action as may
be decided by the University.

Signature of Candidate
Date:
Place:

Signature of Parent/Guardian

Website: www.spsu.ac.in
Completed Application Forms submitted by post should be addressed to the City office, Sir Padampat
Singhania University, c/o JK Cement Ltd., Hill Villa Annexe, Opp. Hotel Hilltop Palace, Ambavgarh, Udaipur
313001, Ph.: 0294-2430102. OR Sir Padampat Singhania University, Bhatewar, Udaipur. Pin- 313601
SPSU Campus: 02957-226095-100.

FOR OFFICE USE ONLY

Documents enclosed:
th

1. Copy of the 10 Standard Certificate

Yes/No

2. Copy of the 10+2 Standard Mark Sheet

Yes/No

3. Copy of the Bachelors Degree Mark Sheet

Yes/No

4. Copy of the Masters Degree Mark Sheet

Yes/No

5. Copy of the Migration/Transfer Certificate

Yes/No

6. List of Publications

Yes/No

7. Copy of the Category Certificate if SC/ST/OBC

Yes/No

8. Two Colour photographs of Candidate

Yes/No

9. Copy of the valid award letter of

CSIR / UGC NET
10. Bankers Cheque/Bank Draft

Yes/No
Yes/No

Verified the list of documents submitted and found to be in order/ not in order (if any deficiency found, the
same should be indicated).

Date:

Signature of Document Verifying Officer

Result of the Admission Test and Personal Interview: Satisfactory / Un-satisfactory

Date:

Signature of the Coordinator

Confirmation of Selection
Mr./Ms. ______________________________Son/Daughter

of ______________________________ has

been selected for Ph.D degree programme in__________________________________________.

Signature of Registrar