ITM UNIVERSITY, GURGAON Formerly Institute of Technology and Management ITM Autonomous Institute

(To be filled by ITMU) Receipt No Date

APPLICATION FORM FOR ADMISSION TO Ph.D PROGRAMME FOR ACADEMIC SESSION 2012 2013
All columns need to be filled with black ball point pen only

Name of the Applicant (IN CAPITAL LETTERS) Fathers Name Mothers Name Name of Guardian Address
PASTE FIRMLY YOUR RECENT COLOR PHOTOGRAPH OF GOOD QUALITY (SIZE 3.5 X 4.5 CMS)

PIN Phone (with STD Code) Mobile No. E-Mail:

National / State level test : (NET/NET-JRF/GATE/SLET) or any other: Roll No. M.Phil: YEAR Score UNIVERSITY Rank Year SCORE

Are you in receipt of any Fellowship (JRF/SRF): Date of Birth Gender Nationality Blood Group

SIGNATURE OF THE APPLICANT

ITM University has been established by the Haryana State Legislature under The Haryana Private Universities (Third amendment) Act, 2009. ITM University is a Private University set under Section 2(f) and has the right to confer degrees under Section 22(1) of the UGC Act, 1956. ITM University has been included by UGC in their select list of approved Universities. This list of recognized Universities can be obtained from the UGC website www.ugc.ac.in www.itmindia.edu

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Academic Qualifications: Examination Secondary, High School or equivalent Sr. Secondary, Intermediate or equivalent Degree in Sc./ Com/ Arts/ Engg./ Mgt. /Law Post Graduate in ....... (Subject) Are you applying as Haryana Domicile? Yes No Category under which admission is sought All India Haryana General Haryana SC Kashmiri Migrant Subject University/Board Year Percentage Marks /CGPA Division

(Besides the All India Category, if eligible, an applicant can also apply for a reserved category)

School/Department in which the candidate proposes to work: a) Subject: b) Department: c) School: Application for Full Time/Part Time Programme Full Time Programme Part Time Programme
Note: Part Time candidates have to submit no objection certificate from the current employer. The candidates are required to pay application fee of Rs. 1,000/- either through cash receipt or DD drawn in favour of ITM University payable at Gurgaon.

SIGNATURE OF THE APPLICANT

ITM University has been established by the Haryana State Legislature under The Haryana Private Universities (Third amendment) Act, 2009. ITM University is a Private University set under Section 2(f) and has the right to confer degrees under Section 22(1) of the UGC Act, 1956. ITM University has been included by UGC in their select list of approved Universities. This list of recognized Universities can be obtained from the UGC website www.ugc.ac.in www.itmindia.edu

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DECLARATION
I have read and understood that ITM University has been established by the Haryana State Legislature under The Haryana Private Universities (Third amendment) Act, 2009 and ITM University is a Private University set under Section 2(f) and has the right to confer degrees under Section 22(1) of the UGC Act, 1956. ITM University has been included by UGC in their select list of approved Universities. This list of recognized Universities can be obtained from the UGC website www.ugc.ac.in I have clearly understood that the functions of Admission, Course Design, Curriculum Structures, Teaching Methodologies, Examinations/ Evaluation System (Internal and External) and all other issues related thereto including but not limited to the credit/ grading system, promotion system etc etc. shall be performed entirely by the university in accordance with the guidelines prescribed in the Statute/ Ordinances as approved by ITM University from time to time. I hereby agree and undertake that if admitted, my child / ward shall abide by all the rules and regulations of ITM University from time to time including but not limited to attendance, course work, Internal / External Examination and evaluation, matters of discipline, timely payment of fee etc. etc. I understand that my admission to ITM University if at all, is provisional and subject to confirmation by Vice-Chancellor I hereby affirm that the information furnished in the Application Form is true and no material information has been concealed. If any information is found to be false, incorrect or misleading, ITM University shall have the authority to cancel my candidature/ admission without any further enquiry or notice. Under the circumstances, all fee paid for whatsoever purpose shall stand fully forfeited. I understand and agree that Ragging and/or Smoking within the premises of the Institute and/or its hostels is illegal and strictly prohibited. I understand that the institute has a ZERO Tolerance policy for indulging in any such act and that, if I am found engaging in any such act(s) or any other unlawfull act(s) directly or indirectly, besides Police/Legal Action against me, I shall be expelled from the University. In such an event my fee shall also be forfeited. I also affirm that I have read in detail the Admission Policy & Selection Procedure 2012-13 of ITM University including its fee structure and refund policy before submitting this application and agree to unconditionally abide by the same. I accept the terms and conditions of the University for the admission/registration.

SIGNATURE OF PARENT/GUARDIAN

SIGNATURE OF APPLICANT

DATE

PLACE

ITM University has been established by the Haryana State Legislature under The Haryana Private Universities (Third amendment) Act, 2009. ITM University is a Private University set under Section 2(f) and has the right to confer degrees under Section 22(1) of the UGC Act, 1956. ITM University has been included by UGC in their select list of approved Universities. This list of recognized Universities can be obtained from the UGC website www.ugc.ac.in www.itmindia.edu

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FORM 1 HARYANA RESIDENT CERTIFICATE (For bonafide Residents of Haryana only) Certified that Sh./Km. ___________________________ son/daughter R/o of Sh./Smt. ____

____________________________________________________

________________________________________________________________________ (complete address) since _________________________________________ and applicant for admission to Engineering/ Technical Courses at ITM, University Gurgaon, Haryana, is a bonafide resident of Haryana State in terms of Chief Secretary, Haryana letter o. 62/17/95 6 GSI dated 3.10.96, letter No. 62/32/2000 6GSI dated 23-5-2003, letter No. 62/27/2003/6 GSI dated 29.7.2003, letter No. 22/28/2003 3GS III dated 30-1-2004 under clause _____________________. No. ___________________ (signature of the attesting authority)

Date : _________________

Name _____________________________

Place: _________________ NOTE: i) ii)

Designation ________________________ (with legible office seal)

iii)

The competent authorities to issue Haryana Resident Certificate will be as per State Govt. letter No. 22/28/2003 3 GS III dated 30.01.2004. The candidates, who have passed their qualifying examinations from the Universities / Board / Institutes located in Haryana, are not required to produce Certificate of Haryana Resident. The certificate must have been issued on or after 31-1-2005.

FORM 2 SCHEDULED CASTE CERTIFICATE (For SC Candidates only) Certified son/daughter that of Sh./Km.__________________________________________________ Sh./Smt. __________________________________________ R/o

_________________________________________________________________ ________________________ (complete address) belongs to _________________

____________ Caste which has been notified as Scheduled Caste by the Haryana Government.

This certificate is being issued to him/her according to the Haryana Govt. circular Letter No. 333(I) 97, dated 25-2-97, No. 22/28/2003 3 GS III dated 30.01.2004 and letter dated 216-2004.

No. ___________________

(signature of the issuing authority)

Date: _________________ Place: _________________

Name _____________________________ Designation ________________________ (with legible office seal)

AFFIDAVIT (Mandatory for all Candidates) (To be executed on a Rs.10/- Non-judicial Stamp Paper duly attested by a First Class Magistrate or Notary Public) I, ______________________, D/O / S/0 /W/O of __________________ aged about _____ years R/O ____________________________________________________, do hereby solemnly affirm and declare as under: 1. That my self has applied and has been offered admission at ITM University, Sector23A, HUDA, Gurgaon in ____________Course. His/her GATE Score ________________ (as the case may be). 2. That I have read over and understood the rules and regulations of the University and have executed an Undertaking/Declaration on my own free will and consent along with my son /daughter without any force, fraud and coercion. I shall abide by the undertaking / declaration and the rules and regulations of ITM-University failing which the university shall be free to take such action as may be decided by the Institute including cancellation of my admission.

3. That I have clearly understood the refund and cancellation policy of the University and the financial impact of a mid-course withdrawal on an unaided self finance University like ITM. Therefore, in the event my child withdraws his/her admission after the last date of withdrawal i.e. 27 th June 2012 or mid-course before the completion of the course, I undertake to pay the balance years tuition and development fee since the seat cannot be filled by the University mid-course and shall therefore remain vacant, Being an unaided self financed University, I am aware that the University is entitled to claim the said amounts in view of the Constitution Bench judgment of the Honble Supreme Court of India in the case titled Islamic Academy of Education vs. State of Karnataka bearing CWP No. 350 of 1993.

4. That I undertake to pay the university the fee as stated herein above on the basis of a written demand made by the university at my aforesaid address and the same shall be a conclusive proof of the seat remaining unfilled at the university after the withdrawal of admission by my child. 5. That the demand for the balance years fee by the university shall be final and acceptable to me and I undertake not to question the same and undertake to pay the same within the period as stated in the demand letter. In case I fail to do so, besides withholding my no dues clearance/migration/character certificates, the institute shall be entitled to take legal recourse to recover the same at my risk and peril as to costs and consequences. 6. That the contents of this affidavit have been read over and explained to me in vernacular and I am executing the same after understanding the contents thereof. DEPONENT VERIFICATION: Verified at Place _______ on this ______ day of ________________ 2012 that the contents of paragraphs 1 to 6 of the above affidavit are true and correct to my knowledge and no part of it is false and nothing has been concealed there from. DEPONENT