Every column to be carefully filled in by the Candidate. 1. 2. 3. 4. Name of Treasury. Chalan No. Amount Rs Date of Remittance.

Candidates are expected to give precise and correct information on the various points required in each column. Failure to do so will result in the application being rejected without further noticed.

UNIVERSITY OF CALICUT
FORM OF APPLICATION FOR PREQUALIFICATION AND ELIGIBILITY TEST FOR ADMISSION TO PH.D DEGREE IN ENGINEERING / TECHNOLOGY
1. 2. 3. 4. 5. 6. Name (In block letters) as entered in original Qualifying Certificate Sex Age and Date of birth Religion & Community with sub-division, if any Do you belong to SC/ST Category Permanent Home Address (in block letters)

7.

Address to which communications are to be sent (in block letters) With Pin code & Phone No.

8.

email id (in CAPITAL Letters)

9.

Research Department in which the Admission is sought (Tick the appropriate Department)

Civil Engineering Mechanical Engineering Electrical & Electronics Engineering Chemical Engineering

10.

Type of Admission sought for

Full Time Part Time

11.

Year of passing the Qualifying Examinations. Name of Exam, Register No., and Name of the University with Branch, % Marks obtained (Degree certificate and mark list to be enclosed.) Total experience after obtaining the Basic Degree in Engineering Are you exempted from writing the eligibility test for PhD.? Whether the candidate has paid the fees for the Prequalification and Eligibility Test Provide the details of Chelan / DD (Candidates exempted from writing eligibility test shall apply for prequalification by paying the application fee of Rs.50. Others have to pay a fee of Rs.550.)

12.

Teaching : . Years, . Months Industry : . Years, . Months

13. 14.

I hereby certify that the entries made above are correct to the best of my knowledge and that they have been made in my own handwriting.

Station : Date : Signature of the Candidate

Head of Account :

The amount should be remitted in any of the Government Treasuries in Kerala State 8443-00-106 P.D. Account of Calicut University for remittance in the Treasuries in Malappuram District and 8658-102-04 (I) B CUS for remittance in other Treasuries in the State. Examination fee once remitted will not be refunded or adjusted towards a subsequent Examination.

(To be filled only in the case of candidates appearing for written examination)

UNIVERSITY OF CALICUT

Reg. No :

Form to accompany Applications of candidates for admission to University Examinations - Ph.D in Engineering Preliminary Qualifying Examination June/December 2013 Name of Candidate.Date of birth.. (In block letters) Address ...

----------------------------------------------------Identifying Officers Name, Designation, And address -----------------------------------------------------------------------------------------------------------------------------------------------------------Passport size Photograph to be pasted here

Signature of the Identifying Officer with Seal

(To be signed on the photograph)

Station : Date :

Signature of the candidate

(To be signed in the presence of the Identifying Officer)

UNIVERSITY OF CALICUT HALL TICKET Ph.D in Engineering Preliminary Qualifying Examination June/December 2013 Centre of Examination
Name of candidate (in block letters) Register Number Subject
(This column will be filled in by the Controller of Examinations office)

-------------------------------------------------Passport size photograph to be pasted here

Identifying Officers Name, Designation and Address

---------------------------------------------------------------------------------------------------------------------------------------------------

Signature of the Identifying Officer with Seal

(To be signed on the photograph)

Signature of the Candidate.

(To be signed in the presence of Identifying Officer)