BHAGWANT UNIVERSITY, AJMER
BURET - 2018
Application Form
(Date of Examination: Sunday, 7th Jan, 2018)
Form No.________________________ Registration No._________________________
(For office Use) (For office Use)
Program applied for: M.Phil Ph.D. Department:........................................
(Please fill in the Application Form in BLOCK LETTERS)
Name (Mr./Mrs./Ms.) _________________ _________________ ______________
Surname First Name Middle Name
Recent Passport
Father’s Name _________________ _________________ _________________ Size Photograph
Surname First Name Middle Name
Mother’s Name _________________ _________________ _________________
Surname First Name Middle Name
Date of Birth Nationality_________________
Date Month Year Religion _________________
Caste Category: SC/ ST/ OBC/ General
Address: ___________________________________________________________________________
____________________________________________________ Pin
Landline________________ _____ _________Mobile_______________________________________
Office: _______________________________________________________________________________
____________________________________________________ Pin
Landline______________________________ Mobile_______________________________________
Email ID ____________________________ Aadhar No. ____________________________________
Marital Status: Single Married Gender: Male Female
Hostel Facility Required: Yes No
Educational Qualifications:
Examination Institution Board/University % Year Subject
Secondary
10+2
Graduation
Post graduation
Any other
qualification
1
Extra-curricular activities and honors received (if any)__________________________________
______________________________________________________________________________________
Entrance Fee Paid Details: Rs. 1100 paid vide ……………………………………………………..
DECLARATION BY CANDIDATE
I, Mr./Mrs./Ms._________________________________________________________hereby declare that
the information furnished in this form is true to the best of my knowledge and belief. I am submitting this
application, with the understanding that I am eligible for M.Phil/ Ph.D. admission as per UGC norms. If
later, I am not found eligible as per UGC norms, my candidature may be cancelled/ terminated by Bhagwant
University Ajmer.
Date:____________________ Signature of Applicant
Kindly forward the duly filled application form along with the DD of Rs. 1100/-in favor of 'BHAGWANT
UNIVERSITY' payable at Ajmer, by speed post/courier/personal visit on the address given below: (Latest
by Monday, 18th December, 2017)
Bhagwant University
Sikar Road,
Ajmer (Rajasthan)-305004
Mob.-+91-9928144442/ 43
2
BHAGWANT UNIVERSITY, AJMER
BURET - 2018
CENTRE’S COPY
Roll No.__________________________
Name of Candidate:________________________________________ Self Attested
Passport size
Father’s Name: ___________________________________________ photograph
Address for Correspondence:________________________________
______________________________________________________________________________________
Choice of Centre by the Candidate:______________________________________________________
Centre allotted by the University:_________________________________________________________
Date & time of Test: SUNDAY JANUARY 07, 2018, 11.00 AM
Signature of Candidate Coordinator (BURET-2018)
BHAGWANT UNIVERSITY, AJMER
BURET - 2018
CANDIDATE’S COPY
Roll No.__________________________
Name of Candidate:____________________________________________ Self Attested
Passport size
Father’s Name: _______________________________________________ photograph
Address for Correspondence:____________________________________
______________________________________________________________________________________
Choice of Centre by the Candidate:______________________________________________________
Centre allotted by the University:_________________________________________________________
Date & Time of Test: SUNDAY JANUARY 07, 2018, 11.00 AM
Signature of Candidate Coordinator (BURET-2018)
