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i
UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
APPLICATION FOR LETTER OF PERMISSION TO SEEK RESEARCH VISA (FOR FOREIGN STUDENTS)
01 Name
02 Qualification
03 Permanent Address (in the country of residence with Phone Number)
04 Contact Address in Mysuru with Phone Number
05 Place of work with Address (if employed)
06 Institution where doctoral research will be carried out
07 Name of the Guide
08 Subject in which he/she wishes to pursue research
09 Title of the research topic :
Signature of the Applicant with date
Signature of the Research Guide
(with seal)
Signature of the Chairperson/ Director / Co-ordinator /
Principal (with seal)
Enclosures
The following documents are to be attached with this application :
A. Marks Cards of Masters Degree Examination (All semesters)
B. Letter of Acceptance from the Guide (Original)
C. Copy of Latest Passport
D. Research Proposal
E. Certificate of Eligibility (those with degrees awarded by University of Mysore are exempted from producing this certificate)
Application No. :
ii
UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
APPLICATION FOR PROVISIONAL REGISTRATION FOR Ph.D. in _______________
01 Name
02 Highest Education Qualification (Enclose Photo copies duly attested)
Post Graduate Degree & Subject
Year of Passing / Appearing
Percentage of Marks Secured
Specialization University
03 Permanent Address of the Candidate 04 Name & Official Address of the Guide
04 Contact Number / Email ID
05 Category : GM/SC/ST/Cat-1/OBC/PH
06 Address of place of work, if employed
07 Department / Research Centre recognized by University of Mysore, where Doctoral Research will be carried out
08 Status : with /without fellowship / in service*
*(those employed must enclose the NOC)
09 Name and Official address of the Co-guide(s), if any
10 Whether cleared UGC JRF/UGC-CSIR JRF/GRE / GATE / NET / SLET / M.Phil through Entrance (Enclose photo copy of the relevant documents duly attested)
11 Details of fee paid : Name of the Bank and Branch
DD/ Challan No. ______________________ Date ________________ Amount _______________
I certify that the above information furnished is true to the best of my knowledge.
-------------------------- -------------------------- --------------------------------- Signature of the Signature of the Counter Signature of Candidate Guide & Co-guide (s), if any Chairperson / Director (with date) (with seal & date) (with seal & date) Enclosures : The following documents are to be attached along with the form for Provisional Registration.
1. Attested photocopies of Masters Degree Certificate and Marks Cards. 2. Attested photocopy of Fellowship award document (for candidates with fellowship). 3. No Objection Certificate from the Employer, in Original (for in-service candidates). 4. Acceptance Certificate from the Guide and Co-Guide(s), in original. 5. Guide’s declaration Certificate about number of candidates presently working under him/her. Similar
declaration from co-guide(s), if any. 6. Bank Challan (Original) for having remitted the provisional registration fee.
7. Migration Certificate for other University Students, NOC (from International Centre), Research Visa & Residential Permission Letter (from Police Commissioner) for the Foreign National Candidates.
Affix Stamp Size
Photo
Application No. :
iii
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
………………………………………………………. «µÀAiÀÄzÀ°è ¦ºÉZï.r ¥ÀzÀ«UÁV £ÉÆÃAzÀt Cfð
APPLICATION FOR REGISTRATION FOR Ph.D. DEGREE IN THE SUBJECT
…………………………………………………………………………… (2010 wzÀÄÝ¥Àr ¤AiÀĪÀiÁªÀ½UÀ¼À ¥ÀæPÁgÀ) [as per 2010 Regulations (Amendment)]
01 ¸ÀA¥ÀÇtð ºÉ ÀgÀÄ (zÀ¥ÀàPÀëgÀUÀ¼À°è) Name in full (in block letters)
02 SÁAiÀÄA «¼Á¸À Permanent Address in full
zÀÆgÀªÁt ¸ÀASÉå : Telephone No. :
F-CAZÉ : E-Mail :
03 °AUÀ : Sex :
UÀAqÀÄ / ºÉtÄÚ Male /Female
gÁ¶ÖçÃAiÀÄvÉ Nationality
04 ¥ÀæªÀUÀð
Category
¸ÁªÀiÁ£Àå / ¥À.eÁ. /¥À.¥ÀA / ¥ÀæªÀUÀð-1 General / SC / ST / Category 1
05 ¸ÁßvÀPÉÆÃvÀÛgÀ ¥ÀzÀ«UÀ¼À «ªÀgÀUÀ¼ÀÄ Details of Post-graduate Degrees
¥ÀzÀ«
Degree
«±Àé«zÁ央AiÀÄzÀ ºÉ¸ÀgÀÄ Name of the University
ªÀµÀð
Year
CzsÀåAiÀÄ£À ªÀiÁrzÀ «µÀAiÀÄUÀ¼ÀÄ Subjects Studied
±ÉæÃtÂ/ zÀeÉð
Class / Grade
±ÉÃPÀqÀ CAPÀUÀ¼ÀÄ
Percentage Marks
¸ÁßvÀPÉÆÃvÀÛgÀ PG
JA.¦ü¯ï M.Phil
06 GzÉÝòvÀ ¦ºÉZï.r. ªÀĺÁ¤§AzsÀzÀ ²Ã¶ðPÉ ªÀÄvÀÄÛ ¨sÁµÁ ªÀiÁzsÀåªÀÄ (GzÉÝòvÀ PÁAiÀÄð AiÉÆÃd£ÉAiÀÄ£ÀÄß F CfðAiÉÆqÀ£É ®UÀwÛ¸À ÉÃPÀÄ) Title of the proposed Ph.D. thesis and language (Proposed Synopsis must be enclosed with this application)
07 GzÉÝòvÀ ¸ÀA±ÉÆÃzsÀ£Á PÁAiÀÄðªÀ£ÀÄß ¤ªÀð»¸À®Ä ªÀÄvÀÄÛ ªÀĺÁ¥Àæ§AzsÀªÀ£ÀÄß ¹zÀÞ¥Àr¸À®Ä C¨sÀåyðAiÀÄÄ DAiÉÄÌ ªÀiÁrPÉÆArgÀĪÀ ¸ÀA¸ÉÜAiÀÄ ºÉ ÀgÀÄ ªÀÄvÀÄÛ «¼Á¸À Name and address of the Institution chosen to carry out the proposed research work and prepare the Ph.D. thesis
08 C¨sÀåyðAiÀÄÄ ¦ºÉZï.r ¥ÀzÀ«UÉ ºÉ¸ÀgÀÄ zÁR°¹zÁÝgÉAiÉÄÃ? ºÉ¸ÀgÀÄ zÁR°¹zÀÝgÉ, MAzÀÄ ¥ÀæwAiÉÆqÀ£É, DzÉñÀzÀ G¯ÉèÃR ªÀÄvÀÄÛ ¢£ÁAPÀªÀ£ÀÄß ¤Ãr Has the Candidate enrolled for Ph.D.
Degree? If Yes, provide order reference with date and a copy of the order
ºËzÀÄ / E®è Yes / No
09 ªÀiÁUÀðzÀ±ÀðPÀgÀ «ªÀgÀUÀ¼ÀÄ Details of the Supervisor
ªÀiÁUÀðzÀ±ÀðPÀgÀ ÀA¥ÀÇtð ºÉ ÀgÀÄ Supervisor Name in full
Affix Stamp Size
Photo attested by the HOD
Application No. :
iv
¥ÀÇtð «¼Á À Address in full zÀÆgÀªÁt ¸ÀASÉå : Telephone No. :
F-CAZÉ : E-Mail :
10 ¸ÀA±ÉÆÃzsÀ£Á C¨sÀåyðAiÀÄ ¸ÁÜ£ÀªÀiÁ£À Status of the research Candidate
Full Time / Part Time
11 C¨sÀåyðAiÀÄ ¸ÀA±ÉÆÃzsÀ£Á «zÁåyðªÉÃvÀ£À ¥ÀqÉAiÀÄÄwÛgÀĪÀgÉ?
Is the candidate getting research fellowship?
ºËzÀÄ / E®è Yes / No
ºËzÉAzÀgÉ, ¸ÀA±ÉÆÃzsÀ£Á «zÁåyð ªÉÃvÀ£À ¤ÃqÀÄwÛgÀĪÀ ¸ÀA¸ÉÜAiÀÄ ºÉ¸ÀgÀÄ If Yes, Name of the Institution granting the research fellowship
¸ÀA±ÉÆÃzsÀ£Á «zÁåyðªÉÃvÀ£À UÀ½¹zÀ ¢£ÁAPÀ Date of selection granting the research fellowship
¸ÀA±ÉÆÃzsÀ£Á «zÁåyðªÉÃvÀ£ÀzÀ CªÀ¢ü Duration of the research fellowship
J¥sï.L.¦ / EvÀgÉ (zÀAiÀÄ«lÄÖ £ÀªÀÄÆ¢¹) F.I.P / Others (please specify)
12 C¨sÀåyðAiÀÄÄ GzÉÆåÃUÀzÀ°è EgÀĪÀgÉÃ? (GzÉÆåÃUÀzÀ°èzÀÝgÉ, GzÉÆåÃUÀzÁvÀjAzÀ ¤gÁPÉëÃ¥ÀuÁ ¥ÀvÀæ ¸À°è À¨ÉÃPÀÄ. E®è¢zÀÝgÉ, GzÉÆåÃUÀzÀ°è E®è JAzÀÄ ¸ÀéAiÀÄA-WÉÆõÀuÁ ¥ÀvÀæ ¸À°è¸À¨ÉÃPÀÄ) Is the candidate Employed?
(If Yes, No-objection Certificate from the employer must be furnished. If not employed, a self declaration must be furnished stating „Not employed‟)
ºËzÀÄ / E®è Yes / No
13 Cfð ªÀÄvÀÄÛ £ÉÆÃAzÀt ±ÀÄ®Ì ¥ÁªÀw¹zÀ «ªÀgÀUÀ¼ÀÄ Details of payment of Application and Registration fees ZÀ®£ï / gÀ²Ãw ¸ÀASÉå ªÀÄvÀÄÛ ¢£ÁAPÀ (ZÀ®£ï / gÀ²ÃwAiÀÄ ªÀÄÆ® ¥Àæw ®UÀwÛ¹) Challan / Receipt number and date (Please enclose
original Challan / receipt)
14 WÉÆõÀuÉ : F CfðAiÀÄ°è ¤ÃrgÀĪÀ J®è ºÉýPÉUÀ¼ÀÄ ªÀÄvÀÄÛ «ªÀgÀuÉUÀ¼ÀÄ £À£Àß £ÀA©PÉUÉ w¼ÀĪÀ½PÉUÉ ¤d, ÀA¥ÀÇtð ªÀÄvÀÄÛ ¸ÀjAiÀiÁVªÉ JAzÀÄ F ªÀÄÆ®PÀ WÉÆö¸ÀÄvÉÛãÉ. AiÀiÁªÀÅzÉà ¸ÀAzÀ¨sÀðzÀ°è £Á£ÀÄ E°è ¤ÃrgÀĪÀ AiÀiÁªÀÅzÉà ªÀiÁ»wAiÀÄÄ ¸ÀļÀÄî CxÀªÁ vÀ¥ÀÄà JAzÀÄ PÀAqÀħAzÀ ¥ÀPÀëzÀ°è ¦ºÉZï.r ¥ÀzÀ«UÁV £À£Àß GªÉÄÃzÀĪÁjPÉAiÀÄÄ gÀzÁÝUÀĪÀ ¸ÁzsÀåvɬÄzÉ JA§ÄzÀ£ÀÄß £Á£ÀÄ CjvÀÄPÉÆArzÉÝãÉ. Declaration: I hereby declare that all statements and details given in this application are true, complete and correct to the best of my knowledge and belief. I understand that in the event of any information being found false or incorrect, my candidature for Ph.D. degree is liable to be cancelled.
¸ÀܼÀ : Place : ¢£ÁAPÀ : Date :
C¨sÀåyðAiÀÄ ¸À»
Signature of the Candidate
ÀA±ÉÆÃzsÀ£Á ªÀiÁUÀðzÀ±ÀðPÀgÀ µÀgÁ, À» ªÀÄvÀÄÛ ªÉƺÀj£ÉÆqÀ£É Remarks of the Supervisor with signature and seal
ÀA¸ÉÜAiÀÄ ªÀÄÄRå ÀÜgÀ À», ªÉƺÀj£ÉÆqÀ£É
Signature with seal of Head of Institution
v
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
APPLICATION FOR Ph.D. DEGREE – (to be sent along with the thesis)
SUBJECT : ________________________________________________________________________
01 Name and Address in Full
02 Age, Nationality and Caste
03 Qualifying Exam and Year of Passing the same
04 Correlated subject in the qualifying examination
05 The date of registration to work the Ph.D. Degree
06 Title of the Thesis :
07 Details of fee paid : Name of the Bank and Branch
DD/ Challan No. ______________________ Date ________________ Amount _______________
08 Name of the institution in which the candidate is working
09 Whether the certificate from the Professor under whom the candidate was taking guidance is attached
10 Whether the Thesis or Part of it was the basis for the award of a Degree or Fellowship previously
11 Date of submission of the Thesis
I declare that the Thesis I am presenting entitled ………………………………………………………..
…...…………………………………………………………………… is prepared by me under the guidance of
………………………………………………………………………………………………………………………...…
and has not formed the basis of the award of any Degree or Fellowship previously.
Signature of the Signature of Signature of the Applicant the Guide Head of the Institution
Application No. :
vi
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
ENCLOSE THE FOLLOWING DOCUMENTS WITH THE SUBMISSION OF THESIS
01 Duly filled in application form for the Thesis submission
02 Plagiarism certificate by the library
03 Candidate Certificate Should be certified by the guide and Chairman
04 Attendance Certificate by the Guide
05 Research Guide Certificate for the Thesis and Research Publications
06 Verification Certificate by the Doctoral Committee about the Research Publications (Certificate should be enclosed)
07 Ph.D. Permanent Registration Copy
08 Guide Recognition Certificate
09 Ph.D. Course-work Passed Certificate
10 Date of Pre-Registration Colloquium
11 Pre-submission Colloquium Report (signed by Doctoral Committee Members)
12 Photo copies of 10th & Master Degree Marks Cards & Convocation Certificate
13 Date of Ph.D. Registration Extension Letter
14 FOUR copies of Ph.D. Thesis
15 TEN copies of Final Synopsis
16 Submission fees paid ORIGINAL Challan (SC/ST & Cat – 1, 50%)
17 Soft copy of TWO CD Certified & Verified by Guide & Chairman
18 Two Copies of the Publication (Journals Xerox) Certified by the Guide & Chairman
19 NOC from Library, Department & Hostel
20 Emblem should not appear in the thesis
21 Service fees paid by per Candidate, ORIGINAL Challan (Registered through affiliated and other Research Institutes)
22 Laboratory Fee Challan‟s – Xerox copies
For Foreign National Students (along with above said documents)
23 Visa & Passport
24 Residential Permit (As per Police Report {RP & RC})
25 NOC from International Centre
26 All Progress Report Challan‟s – Xerox copies
27 Special Fees for year :
a. Foreign National Candidates (Fee Challan Xerox) b. Candidates from outside Karnataka [Considered as per SSLC & PG Marks Card (Fee
challan Xerox)]
vii
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
FINAL THESIS SUBMISSION CHECK-LIST (duly filled by candidate)
01 Name of the candidate (in block letters)
02 Name of the Guide (in block letters)
03 Name of the Research Institute
04 Permanent Registration Date
05 Course Work Certificate & Result Date
06 Pre-registration Colloquium Date
07 Pre-thesis submission colloquium date
08 Attendance Certificate from the Guide
09 Research Guide Certificate
10 Verification Certificate by the Guide and Chairman about the research scholar’s Publications
11 Candidate Certificate should be certified by Chairman & Guide
12 Photo Copy of Guide Recognition Certificate
13 Plagiarism Certificate from the University Library
14 Foreign
Nationals Country Name
Passport from & Valid Date
Visa from & Valid date
Residential Certificate from
Police Commissioner
Residential Permit Valid
date
NOC date from International
Centre
15 NOC’s from Library Department Hostel If any others
16 Progress reports, Annual fees paid amount details (Special Fees for FN & Outside of Karnataka)
I Year II Year III Year IV Year V Year Extension Date
VI Year VII Year
17 Laboratory Fees paid date details
I Year II Year III Year IV Year V Year VI Year VII Year
18 Processing Fees amount paid details (for other institutes & guides)
I Year II Year III Year IV Year V Year VI Year VII Year
19 Service Fees amount paid details (one time for other Institutes)
20 Thesis Submission Fees
2 Soft Copies of Thesis
2 Copies of Publications
Date of Certificate from Library for Submission of Thesis Electronic version
Signature of the Candidate Signature of the Guide with seal
viii
UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
ANNUAL FEE SUBMISSION FORM
01 Name of the Candidate
02 Subject
03 Registration Number & Date
04 Annual Fee for the year (Please tick the appropriate year)
First Second Third Fourth
Fifth Extension Sixth Seventh
05 Payment Details
Name of the Bank DD No. / Challan No. DD / Challan Date Amount
06 Address for Communication
07 Contact Number
08 Email ID
09 Name of the Guide and Address
Place : Date : Signature of the Candidate
Signature of the Guide with seal Chairman/Department/Institution Head
ix
UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
CERTIFICATE OF GENUINENESS OF THE PUBLICATION
This is to certify that Ph.D. candidate Mr./Ms./Mrs. ………………………………………..…
Reg. No. ……........................................ Subject: ………......................................... working
under my supervision has published a research article in the standard referred / SCI journal
named ……………………………………..……………………………… with Vol. No…………………
Page Nos ………………….…… and year of publication ………………originally published by
.……………………………………………….………………… the contents of the publication
incorporate part of the results presented in his / her thesis.
Date : Place :
Signature of the Scholar Research Supervisor (with seal)
Chairman / Director
x
UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
ANNUAL PROGRESS REPORT
Period of Report from: ……………………….. to ………………………..
A Name of the Candidate
01 Date of Registration
02 Registration Number
03 Name of the Research Supervisor and Address
04
Tentative title of Ph.D. Thesis
05 Recognized Discipline
06 Course work Completed
07 Will be appearing
08 India/ Foreign Candidate Annual fee attached DD/ Challan
Yes / No
B Progress Report
01 Periodical Discussions held (No. of meetings)
02 Whether a diary is maintained
03 Seminars / Lecture Programme attended
Name Venue Date
04 Conference/ Symposium attended
Name Venue Date
05 Paper Presented (Attach Certificate copy / Copy of Published Article)
06 Manuscript submitted for Publication details
07 Research Paper Published details
08 Books written or published details
09 Any other details
10 Remarks of Research Supervisor
Note : Candidate is required to submit the progress report once in a year within one month of completion of the year.
Signature of the Candidate Signature of the Research Supervisor (with Seal) Signature of the Chairman/ Director
xi
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
APPLICATION FOR CHANGE OF GUIDE / TOPIC
01 Name of the Student
02 Enrollment Number and Date
03 Subject
04 Centre in which enrolled
05 Full address
06 Change required (Guide / Topic)
07 Change for
From To
08 Mode of Payment (Demand Draft in favour of “The Finance Officer, University of Mysore, Mysore” issued by any Nationalised Bank Payable at Mysore or Challan remittance)
DD No. / Challan No. Date Amount Name of the Bank Place of the Bank
Note :
1. Name of the Student with Enrolment No. should be written on the reverse side of the Demand Draft.
2. Student should enclose “No-Objection Certificate” from the guide. 3. Consent and Declaration letter from the guide.
Date : Place : Signature of the Candidate Signature of the Guide Signature of the Chairman/ Director
xii
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
APPLICATION FOR Ph.D. COURSE WORK EXAMINATION
Appearing Subject : .....................................................
01 Name of the candidate
(in Block Letters)
02 Name of the Guide
03 Name of the Research Centre
04 Address for Communication
05 E-mail ID
06 Provisional Registration Date
07 Date of Enrolled for Course work
08 Date of Birth 09 Gender 10 Category
11 Details of fee paid
Name of the Bank Challan / DD Number
Date Amount
Signature of the Signature of the Signature of the Chairman/ Candidate Guide Head of the Institution
Affix recent
passport size photo
Attested by the HOD
xiii
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
Ph.D. COURSE WORK EXAMINATION : ......................................
ADMISSION CARD
(To be retained by the Candidate to use on the day of Examination)
DATE OF EXAMINATION : ………………………………….
Roll No. :
Name :
Subject :
Exam Centre :
Timings Signature of the Invigilator
Important Note:
1. The candidates will not be allowed to examination hall without this admission card. The candidates should also bring along one valid photo ID proof.
2. Electronic device/cellular phone/mobile/pager/calculator/log tables etc. shall not be allowed in the Examination Hall/Room.
3. The candidate will be permitted to appear at the allotted venue of the Ph.D. examination only. 4. The request for change of Test Centre/Venue of test will not be entertained. 5. No TA will be paid for appearing in the examination.
Signature of the Signature of the Chairman/ Candidate Head of the Institution
Affix recent
passport size photo
Attested by the HOD
xiv
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
APPLICATION FOR Ph.D. COURSE WORK MAKEUP EXAMINATION
Appearing Subject : ..............................................................................
Paper : ..............................................................................
01 Name of the candidate (in Block Letters)
02 Name of the Guide
03 Name of the Research Centre
04 Address for Communication
05 E-mail ID
06 Provisional Registration Date
07 Date of Enrolled for Course work
08 Date of Birth 09 Gender 10 Category
11 Details of fee paid
Name of the Bank Challan / DD Number
Date Amount
Signature of the Signature of the Signature of the Chairman/ Candidate Guide Head of the Institution
Affix recent
passport size photo
Attested by the HOD
xv
ªÉÄʸÀÆgÀÄ «±Àé«zÁ央AiÀÄ UNIVERSITY OF MYSORE
Research Centre, Pareeksha Bhavan, Mysuru – 570005, Karnataka, India
Ph.D. COURSE WORK MAKE-UP EXAMINATION : ....................................
ADMISSION CARD
(To be retained by the Candidate use on the day of Examination)
DATE OF EXAMINATION : ………………………………….
Roll No. :
Name :
Subject :
Paper :
Exam Centre :
Timings Signature of the Invigilator
Important Note:
1. The candidates will not be allowed to examination hall without this admission card. The candidates should also bring along one valid photo ID proof.
2. Electronic device/cellular phone/mobile/pager/calculator/log tables etc. shall not be allowed in the Examination Hall/Room.
3. The candidate will be permitted to appear at the allotted venue of the Ph.D. examination only. 4. The request for change of Test Centre/Venue of test will not be entertained. 5. No TA will be paid for appearing in the examination.
Signature of the Signature of the Chairman/ Candidate Head of the Institution
Affix recent
passport size
photo
Attested by
the HOD