BABASAHEB BABASAHEB BHIMRAO AMBEDKAR UNIVERSITY Form No.

BHIMRAO
AMBEDKAR
UNIVERSITY Vidya Vihar, Raebareli Road, Lucknow- 226025
Ph.D. ENTRANCE TEST 2011-2012
ATTENDANCE SHEET
izKk 'khy d#.kk
ESTABLISHED 1996

Course Code Roll Number

Paste
self-attested
passport
Centre of the Test : __________________________________________
photograph
Date & Time of Test : __________________________________________ here
( To be filled by office)

1. Name of the candidate

2. Name of candidate's father/husband

3. Name of candidate's mother

....................................................
Candidate's Full Signature
.................................................... ......................................................................
Signature of Invigilator Candidate's Signature ( In the presence of Invigilator)

BABASAHEB
BHIMRAO
AMBEDKAR BABASAHEB BHIMRAO AMBEDKAR UNIVERSITY Form No.
UNIVERSITY
Vidya Vihar, Raebareli Road, Lucknow- 226025
Ph.D. ENTRANCE TEST 2011-2012
izKk 'khy d#.kk
ADMIT CARD (Duplicate)
ESTABLISHED 1996

Course Code Roll Number

Paste
self-attested
passport
Centre of the Test : __________________________________________
photograph
Date & Time of Test : __________________________________________ here
( To be filled by office)
1. Name of the candidate

2. Name of candidate's father/husband

3. Name of candidate's mother

4. Address for correspondence

PIN E-mail
....................................................
Signature of Issuing Authority

BABASAHEB
BHIMRAO
AMBEDKAR BABASAHEB BHIMRAO AMBEDKAR UNIVERSITY Form No.
UNIVERSITY
Vidya Vihar, Raebareli Road, Lucknow- 226025
Ph.D. ENTRANCE TEST 2011-2012
izKk 'khy d#.kk ADMIT CARD
ESTABLISHED 1996

Course Code Roll Number

Paste
self-attested
passport
Centre of the Test : __________________________________________ photograph
Date & Time of Test : __________________________________________ here
( To be filled by office)
1. Name of the candidate

2. Name of candidate's father/husband

3. Name of candidate's mother

4. Address for correspondence

PIN ....................................................
Signature of Issuing Authority
BABASAHEB
BHIMRAO
AMBEDKAR
BABASAHEB BHIMRAO AMBEDKAR UNIVERSITY
UNIVERSITY
Vidya Vihar, Raebareli Road, Lucknow- 226025
Ph.D. ENTRANCE TEST APPLICATION FORM 2011-2012
izKk 'khy d#.kk
ESTABLISHED 1996

A. Course Code B. Category C. Nationality D. Centre Code Roll Number

(See Prospectus for codes)

( To be given by office)
Course Applied for : __________________________ Department : __________________________
Note:
(i) Read the instructions/guidelines in the prospectus carefully before filling up the form. Paste
(ii) All the entries below should be made in capital English Alphabet. self-attested
(iii) No entry should be left blank. Candidate should fill in the form in her/his own handwriting. passport
(iv) Leave one box between the first name, middle name and surname. photograph
here
1. Name of the candidate

2. Name of candidate's father/husband

3. Name of candidate's mother

4. Place of birth 5. Date of Birth

Date Month Year

6. Sex (Write M for male, F for Female) :
7. Permanent Address (Leave one space after every complete word)

PIN Phone, if any :

8. Address for correspondence (Leave one box after every complete word)

PIN
Phone, if any E-mail
9. Academic record (Produce original and attested photocopy of all marksheet/ certificate at the time of counselling, if called)
Exam. Passed/Appeared Year Board/University Roll No. Subject % Marks
High School/Equivalent
Intermediate/Equivalent
BA/BSc/BCom/BSc (Ag.)
MA/MSc/LLB/Any other

10. If you are applying for admission to any other course (s) in this University, give the Course Code (s)

11. Have you ever been fined / suspended / rusticated / given any other punishment in your educational / professional career ?
If yes, specify the punishment.
12. Bank Draft No. ...........................Amount ................................Name of bank .............................(In case, form is
downloaded from website)

PIN

Declaration
(i) I have read the rules and regulations regarding admission to the University as laid down in this Prospectus.
(ii)The personal details supplied by me in this application form are true to the best of my knowledge and belief.
(iii)
I have not concealed/misrepresented any fact pertaining to the entries made herein.
(iv)In case any statement made by me in this application form does not confirm to facts and is so found at any date in the
future, the University shall be free to take appropriate action against me and the responsibility for any subsequent
loss/harm/damage to my career shall be entirely mine.
(v) I hereby give the undertaking to observe and abide by the rules of conduct of the University, failing which I shall be liable
to disciplinary action.
Place .......................................... .........................................................
Date ........................................... Full Signature of Candidate

Enclosures : Please enclose the following documents with the application form.
(i) Mark-sheet/Grade-sheet and certificate of examinations passed (from 10th onwards to Post graduate level)
(ii) Character Certificate (self-attested)
(iii) SC/ST/PH Certificate (self-attested)
(iv) Two self-addressed envelopes (size 10 X 23 cm) [ One of these two should be stamped envelop of Rs. 30/-].