FORM-R1

ANDHRA UNIVERSITY
DIRECTORATE OF ADMISSIONS

ORIGINAL
Registration No.

APPLICATION FORM FOR FULL-TIME M.Phil./Ph.D. RESEARCH ADMISSION

Last date for receipt of filled-in applications without fine: 20-06-2013 (5 p.m.);
With late fee of Rs. 1,000/- , 30-06-2013 (5 p.m.)
Note: Admission into M.Phil./Ph.D. degree shall be made in accordance with guidelines specified in the
Resarch admission information Brochure. Strike off whichever is not applicable and put a
mark wherever necessary. Each application should be accompanied by a D.D. of Rs. 800/(Rs.500/- for SC & ST) drawn in favour of Director, Directorate of Admissions, Andhra
University, Visakhapatnam on any Nationalised Bank, payable at Visakhapatnam.

Affix attested
recent
Passport size
photo

1. Particulars of Registration Fee:

Amount: Rs. ............D.D.No. ......................... Date: .................

Name of the Bank: ...................

2. Department Code
& Name
3. Research Programme for which the candidate wants to be considered

M.Phil

Ph.D.

Ph.D. Interdisciplininary

4. Name of the Applicant (in Capital Letters):

SURNAME

NAME

5. Name of the Father / Mother :

(Guardian, if parents are not alive)
DATE

6. Sex: Male
8. Residential status:
9. Reservation Category:

Non-local

Local

SC

MONTH

YEAR

7.Date of Birth:

Female

ST

BC-A

BC-B

Other State

BC-C

BC-D

BC-E

PH

10. Particulars of Qualifying Examination (Attested Xerox Copies of the Marks statements & PC must be
enclosed. Otherwise the application will be Rejected)*
Qualifying
P.G./M.Phil.
Degree

Subject studied /
Specialization

Percentage
of Marks /
CGPA

University

Year of
Passing

11. Whether qualified in NET/APSET :YES / NO

INSPIRE FELLOWSHIP If Yes, indicate the test and
score:

12. Permanent Address:

13. Address for communication:

..............................................................................

....................................................................................

..............................................................................

....................................................................................

..............................................................................

....................................................................................

..............................................................................

....................................................................................

PIN code:.......................Ph.No..................................

PIN code:.......................Ph.No.......................................

Email : .....................................................................

Mobile No : ...................................................................

* T ho se w ho a p p e a r e d f o r fi na l y e a r / Se m e st e r e x a m in a t io ins h a v e to inc lude a ll certific ates till da te.

14. Name of the Research guide in the department

: .............................................................................................
under whose guidance the candidate would like to work.**
15. For candidates who wish to pursue inter-disciplinary research.
(a) Names of the departments in which Inter-disciplinary
research will be pursued
: 1) ......................................................................................
2) ......................................................................................
(b) Names of the guides and their departments in which
inter-disciplinary research will be pursued.
: 1) ......................................................................................
2) ......................................................................................

** This does not entail the candidate to get the allotment under the same guide.

DECLARATION BY THE CANDIDATE

I here by declare that the particulars given in items 1 to 16 above are correct. In the event of any
information being found false, I declare to forego my admission forthwith.

Date:

Signature of the candidate

FORM-R1

ANDHRA UNIVERSITY
DIRECTORATE OF ADMISSIONS

DUPLICATE
Registration No.

APPLICATION FORM FOR FULL-TIME M.Phil./Ph.D. RESEARCH ADMISSION

Last date for receipt of filled-in applications without fine: 20-06-2013 (5 p.m.);
With late fee of Rs. 1,000/- , 30-06-2013 (5 p.m.)
Note: Admission into M.Phil./Ph.D. degree shall be made in accordance with guidelines specified in the
Resarch admission information Brochure. Strike off whichever is not applicable and put a
mark wherever necessary. Each application should be accompanied by a D.D. of Rs. 800/(Rs.500/- for SC & ST) drawn in favour of Director, Directorate of Admissions, Andhra
University, Visakhapatnam on any Nationalised Bank, payable at Visakhapatnam.

Affix attested
recent
Passport size
photo

1. Particulars of Registration Fee:

Amount: Rs. ............D.D.No. ......................... Date: .................

Name of the Bank: ...................

2. Department Code
& Name
3. Research Programme for which the candidate wants to be considered

M.Phil

Ph.D.

Ph.D.Interdisciplininary

4. Name of the Applicant (in Capital Letters):

SURNAME

NAME

5. Name of the Father / Mother :

(Guardian, if parents are not alive)
DATE

6. Sex: Male
8. Residential status:
9. Reservation Category:

Non-local

Local

SC

MONTH

YEAR

7.Date of Birth:

Female

ST

BC-A

BC-B

Other State

BC-C

BC-D

BC-E

PH

10. Particulars of Qualifying Examination (Attested Xerox Copies of the Marks statements & PC must be
enclosed. Otherwise the application will be Rejected)*
Qualifying
P.G./M.Phil.
Degree

Subject studied /
Specialization

Percentage
of Marks /
CGPA

University

Year of
Passing

11. Whether qualified in NET/APSET :YES / NO

INSPIRE FELLOWSHIP If Yes, indicate the test and
score:

12. Permanent Address:

13. Address for communication:

..............................................................................

....................................................................................

..............................................................................

....................................................................................

..............................................................................

....................................................................................

..............................................................................

....................................................................................

PIN code:.......................Ph.No..................................

PIN code:.......................Ph.No.......................................

Email : .....................................................................

Mobile No : ...................................................................

* T ho se w ho a p p e a r e d f o r fi na l y e a r / Se m e st e r e x a m in a t io ins h a v e to inc lude a ll certific ates till da te.

14. Name of the Research guide in the department

: .............................................................................................
under whose guidance the candidate would like to work.**
15. For candidates who wish to pursue inter-disciplinary research.
(a) Names of the departments in which Inter-disciplinary
research will be pursued
: 1) ......................................................................................
2) ......................................................................................
(b) Names of the guides and their departments in which
inter-disciplinary research will be pursued.
: 1) ......................................................................................
2) ......................................................................................

** This does not entail the candidate to get the allotment under the same guide.

DECLARATION BY THE CANDIDATE

I here by declare that the particulars given in items 1 to 16 above are correct. In the event of any
information being found false, I declare to forego my admission forthwith.

Date:

Signature of the candidate

ADDRESS SLIPS

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