Photograph

MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY

BHOPAL– 462003 (M.P.) INDIA
Institute of National Importance

Application form for Ph.D Admission 2021-22

Please read the instructions & Ph.D Ordinance/amendments available on the website www.manit.ac.in. Tick
() the relevant box wherever provided. Attach self attested copies of certificates/marksheet in support of your
claim.

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

Full Time Sponsored Branch/Discipline :

Full Time
MAULANA AZAD NATIONAL: INSTITUTE MAULANAOF AZAD TECHNOLOGY
NATIONAL INSTITUTE PhotographO
Project Staff / JRF At Graduation _____________________
MAULANA BHOPAL–
AZAD NATIONAL 462003 (M.P.) INDIABHOPAL–
INSTITUTE OF TECHNOLOGY 462003 (M.P.) Photo
IND
I. ADMISSION CATEGORT (As per Ph.D

Internal Candidate At Post Graduation

(Deemed University) : _________________
BHOPAL– 462003 (M.P.) INDIA(Deemed University) Photo
MAULANA form
Application AZADfor NATIONAL
Admission INSTITUTE OF TECHNOLOGY
(Deemed Application in M.Tech./MUDP
University) form for Admission in M.T
Please read the instructionsBHOPAL– 462003
given in the information Please(M.P.)
brochureread
before INDIA
theyou
instructions
fill up thegiven
form in the information brochure befo
Department : Applied for : _________________________________________________________
Application
Tick() theformrelevantforbox Admission
wherever provided in M.Tech./MUDP
Tick() the relevant box wherever provid
Please read the instructions(Deemed University)
given in the information brochure before you fill up the form
Discipline: _________________________________________________________
COURSE APPLIED FOR : Application COURSE form
Tick() thefor
APPLIEDAdmission
relevant box whereverin M.Tech./MUDP
provided
FOR :
Please read the instructions given in the information brochure before you fill up the form
Applied in any other department(s) (If yes) (separate application along with IPO/Demand Draft
(separate
COURSE APPLIED FOR : Tick() the relevant boxshould
application
be submitted
wherever along
provided forwith
eachIPO/Demand
course) Draft should be
(i) Name of the Department/Discipline ____________________________________________
(separate application along with IPO/Demand Draft should be submitted for each course)
1. GATE
COURSE : 2. Aggregate
APPLIED FOR %: 1. of GATE 3.Category
: 2.
4.Aggregate
Gate % of 3.Category5. Payment details
4. Gate
ordinance clause 10.1)

(ii) Name other Department/ Discipline ____________________________________________

th th
Score :1. GATE : final year
……………
(separate
2. marks(7application
Aggregate
Score%: of along with
……………
(SC/ST/OBC
IPO/Demand
final
Non year
3.Category Draft
4.marks(7
Gate Gate (SC/ST/OBCIPO/DD
should be submitted for each No.
course)
5.
Non :………
Payment
Gate
OFFICIAL USE

OFFICIAL USE

(iii) Name other Department/ Discipline & ____________________________________________

8th
final
sem.) year marks(7 th
& 8th
sem.) Drawn IPO/DD
on :……… No.
Year : Score
……………..
1. GATE
(Fill separate application forms and : ……………
:
processing 2.
fees for each Year
Aggregate :
% ……………..
/
of (SC/ST/OBC
PH/GEN.)
Department) 3.Category Non Gate
4. Gate / PH/GEN.) 5. Payment
USE USE

th
Year
Discipline : ……………..
: ……….. Total %final
&……………
8 year
sem.)marks(7th: ………..
Discipline Total % ……………
/(SC/ST/OBC
PH/GEN.) AmountDrawn
Rs.:………
IPO/DD onNo.
Score : …………… Non Gate
Sponsored: Sponsore
OFFICIAL

Theory% Total
th % ……………
……
Proposed Research Area (Broad Area) _________________________________________________
Discipline : ……….. & 8 sem.) Theory% …… Date : Amount
…………….
Drawn onRs.
Year : …………….. / PH/GEN.) Sponsored:
Sch.No. …….. Theory%
Class Roll No.%…… …… ……..
Sch.No. Class
BranchRoll
:………..
No. …… Date of Date
Branch : ………
Admission :……
Rs.…
OFFICIAL

Discipline : ……….. Total …………… Amount

Sch.No. …….. Class Roll
TO BE No. ……
FILLED BY THE CANDIDATE
(Enclose Brief description of proposed work _____________________________________________
Theory% ……
Sponsored:
Branch :………..
TO BE FILLED BY THE Date of
CANDID
Date Adm
: ………
1.
In 500 words on a separate sheet)Sch.No. …….. 1. Roll No.
Class TO……BE FILLED BY THEBranch
CANDIDATE
:……….. Date of Adm
a Name(in
1. capital) a Name(in capital)
a Name(in capital)
TO BE FILLED BY THE CANDIDATE
Name(in capital) b1.
Address for b Address for
a Name(in capital)
correspondence correspondence
b Address for
correspondence
Gender/D.O.B. Male Female
b Address Date
for of Birth (dd/mm/yy)
correspondence
Email Id : Email Id : Telephone /Mobile No
Father’s Name Email Id : Telephone /Mobile No
II . PERSONAL

c Permanent c Permanent
Mother’s Name Address Email Id :Address Telephone /Mobile No
c Permanent
Address for Address
correspondence c Permanent
Address
PIN Telephone /Mobile No.
Email Id : Telephone /Mobile No.
Telephone
d Date ofNo.Birthwith STD Code : (Ind Christian
In figures Date of Birth
era) Mob.:
In figures (In Christian
In Wordsera)
Telephone /Mobile No.
Permanent d Date of Birth In figures (In Christian era) In Words
Address e Place of Birth e Place of Birth
d Date of Birth In figures (In Christian era) In Words
e Place of Birth PIN
f f Marital Status
EmailMarital
: e Status
Place of Birth Single Single Married
Telephonef No. with
Marital STD Code
Status : g Mob.:
g Category Single Married
Category
Gen./SC/ST/OBC/Disabled Gen./SC/ST/OBC/Disabled Blood Group:
f
g Marital Status
Category Single Married
h EWS Gen./SC/ST/OBC/Disabled Blood Group:
III CATEGORY Gen Religion SC ST h ReligionOBC PwD
g
h Category
Religion Gen./SC/ST/OBC/Disabled Blood Group:
i Father’s Name i Father’s Name
h Religion
i Father’s Name
j Mother’s Name j Mother’s Name
Father’s Name
 MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY, BHOPAL
Ph.D. Admission 2021-22

Attach the receipt of SBI Collect payment of non-refundable processing fee of Rs. 1500/- for For official use
UR/OBC/EWS and Rs. 1000/- for SC/ST/PwD candidates.
IV. PAYMENT

Payment Details SBI Collect No.

Amount Rs. Date:

Qualifying Exam ___________________________________________(Attach copy of degree)

Discipline ______________________________ Duration of the course (Years) ______________
Name of University/Institute ________________________________ Year of Passing _________

UG PG
V. QUALIFYING EXAM DETAILS

CGPA/Marks obtained in Semester %/ CGPA %/ CGPA Aggregate %/CGPA (Mention Point scale
(UG/PG) (If results I also) {Attach self attested copies of all the
awaited give average mark sheets}
II
%/CGPA upto last
semester passed) III
IV
V

VI

VII

VIII

IX

GATE/NET/CAT/MAT/ Name of Year of Marks obtained (attach Score Card) out of 100
CMAT or any other Exam. passing
equivalent exam passed

Validity from ………………………. to …………………………….

Details of Marks secured in the Examinations other than qualifying examination

Exam/Degree Specialization Institute/ University Year of Passing % Marks/ CGPA

Academic Record.
VI. Previous

10
10+2/Equivalent
UG
PG
Any other
Experience in relevant field only :

Experience (From date to date) Designation Organization

VII. Exp. If Any

Details of Paper published in National/International Journal/Conference

S.No. Details
1
VIII

2
3
4

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

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

Name Name
Address Address

PIN Email PIN Email

XI. 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. Ordinance and subsequent notifications.

XII. 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 during 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.

Date: __________________ Signature of parent/Guardian

 MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY, BHOPAL
Ph.D. Admission 2021-22
(Certificate and format from the employer duly signed & sealed)
(For Sponsored Candidates)
1. Name of the Employing : __________________________________
Origination
2. Type of Organization : Central Government State Government
National Level Research Organization
Public Sector Enterprise
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)
This is to certify that, Mr/Ms.___________________________________________ employed as
________________________ in this organization is sponsored for admission to Sponsored Full 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 the organization has no objection to his/her undergoing Ph.D. program
at MANIT, Bhopal
____________________________

Signature of Applicant Seal & Signature of Competent Authority

Name, Designation

ENCLOSURES (Self attested copies)

1. Qualifying Degree (PG) Yes/No
2. Copy of GATE/NET/CAT Score Card Yes/No
3. Mark sheets of all semesters Yes/No
4. Bachelor Degree (UG) Yes/ No
th
5. 12 Mark Sheet Yes/No
th
6. 10 Mark Sheet Yes/No
7. Category Certificate (SC/ST/OBC-NCL/EWS/PwD) Yes/No
8. Experience certificate Yes/No
9. Publication Details Yes/No
10. SBI Collect receipt copy
11. Any other additional document Yes/No
st
(for claiming OBC NCL category certificate issued after 1 April 21 is required)

Note: Application without valid enclosures is liable to be rejected

 MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY BHOPAL

No Objection Certificate for Admission in to Ph.D. Program (Project Staff)

Reference No. : Date:

To
The Director
Maulana Azad National Institute of Technology
Bhopal (M.P.)

Sub: No objection Certificate

Dear Sir,

We have no objection if Mr./Mrs/Ms., ________________________________

Designation: _______________A project staff, under the project:(title of the project),
Sanction letter no. ______, in the department of ________,is
admitted to the Ph.D. Program in the department of _____________________________
of Maulana Azad National Institute of Technology Bhopal. It is certified that the
said project shall continue for one more year.

If selected, we shall allow him/her to attend classes/research work under the said
project at Maulana Azad National Institute of Technology Bhopal during the Ph.D.
program without affecting normal project work assigned to him/her.

Signature of Project Investigator Signature of Dean (R&C)

(Name)
 MAULANA AZAD NATIONAL INSTITUTE OF TECHNOLOGY BHOPAL

No Objection Certificate for Admission in to Ph.D. Program (Institute

Employer)

Reference No. : Date

It is certified that we have no objection if Mr./Mrs/Ms. ____________________________,

Designation: ________________________,a (regular) employee of this Institute, working in
the department of ____________________________,is admitted in to the Ph.D. Program in
the department of __________________________ at this Institute as a Part Time (Internal).

If selected, he/she shall be allowed to attend classes/research work without affecting

normal duties assigned to him/her.

Signature of Head Signature of Director

(Department)

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