Apr 28, 2012 ... BANARAS HINDU UNIVERSITY. Established by Parliament by notification no.
225 of 1916. International Centre. (Application form for other ...
BANARAS HINDU UNIVERSITY
Application No. (please do not fill)
Established by Parliament by notification no. 225 of 1916
International Centre (Application form for other than Indian Nationals only during Session 2012-13)
Application details:
Recent Photograph duly signed by the candidate
Course Applied for: Subjects opted for UG courses:
1. 2. 3. DD No.: Date: Processing fee* Details: Bank/Branch Amount: * Processing fee: Rs. 2500.00 for SAARC Countries and Rs. 5000.00 for Non SAARC Countries (in the form of Bank Draft drawn in favour of Registrar, Banaras Hindu University, Varanasi.) The candidates willing to pay the above charges in US $ are permitted to do so in amounts equivalent to the Prescribed charges in INR.
Personal details: Name of Candidate: Mr. / Ms.
Married / Unmarried
Date of Birth:
Nationality:
Name of Spouse:
Passport Details:
P.P. No.
Place of Issue:
Date of Issue:
Valid up to:
Country of residence:
Family details: Father’s Name:
Nationality:
Mother’s Name:
Nationality:
Address for Correspondence:
______________________________________________________________
Phone:
______________________________________________________________
Fax:
______________________________________________________________
E-mail:
PIN / ZIP:
Permanent Address:
_____________________________________________________________________
Phone:
_____________________________________________________________________
Fax:
_____________________________________________________________________
E-mail:
PIN / ZIP:
Qualifying Examination details: Name of the Examination:
Grade/% of marks
Examining Board / University:
Language of instruction
Instructions: Specimen Signature 1. No refund of Fees is admissible 2. Incomplete form will not be accepted. 3. This form must be signed by the applicant. 4. This form is valid only for the year of application. 5. Application form unaccompanied with proper processing charge will not be entertained. Send completed forms to: International Centre.C/3/3, Tagore House, Banaras Hindu University, Varanasi-221005, INDIA. email:
[email protected] &
[email protected] , Phone & Fax: 91:0542 2368130 visit us at : www.bhu.ac.in
1
Educational Details: Important: Attach certified copies of all mark sheets and certificates. English version of Documents, Certified by competent authority be also attached in case the originals are in other than English language. Grade Conversion Formula from the Institution is required, if marks not mentioned / awarded in Percent. Name of Examination
Board / University
Year
Subjects Obtained
Marks Max.
%
th
10 Level 10 + 2 Level Bachelors Degree 10+2+3 Level Masters Degree 10+2+3+2 Level Any Other Degree
Mother Tongue: Knowledge of English:
Languages Known: Written: Good / Fair / Poor
Whether earlier studied/admitted to BHU: Yes / No Result:
1.
2.
Spoken: Good / Fair / Poor
Course:
Period:
Passed / Failed / Others (specify details)
Whether studying in BHU:
Yes / No
3.
Enrollment no. Course:
Faculty:
Additional information for admission to Research: Topic of Research: ( enclose synopsis)
Research Publications (enclose details)
No. of Publications
National
International:
Present Occupation / Employment, if any: Professional Experience (enclose details)
Period:
Institution:
DECLARATION I hereby declare that: 1. 2. 3. 4. 5.
The particulars given in this application form are true and authentic to the best of my knowledge and belief. I have read and understood the instructions and I accept them. I under take to return my native country after completion of the course. I will abide by the rules, regulations and policies of the Government of India and Banaras Hindu University. I do accept that the Banaras Hindu University shall have the right to reject my candidature at any time, if any information is found false / fake / wrong at any stage.
Date: _____________ Place: _____________ SIGNATURE OF THE CANDIDATE
2
CHECK LIST for Enclosures along with Application Form (Put 5 mark) Checked the Eligibility Criteria for the admission to the course. All the columns are filled in properly and correctly in this application form. Application form has been signed on both pages and on photograph. Grade Conversion Formula from the Institution attached (if marks not mentioned / awarded in %) English version of Certificates / Documents, certified by competent authority are attached (in case original Certificates / Documents are in other than English language) Bank Draft is attached for Processing fee in favour of REGISTRAR, BANARAS HINDU UNIVERSITY payable at VARANASI. Photocopies of Passport attached. Photocopies of Certificates for Proof of Age and Qualifications attached. Important Dates: 28th April, 2012
Last date of receipt of completed applications Tentative dates to report at International Centre, BHU for joining the course (a) Undergraduate and Postgraduate (including Full-time Diploma courses
25th -31st July, 2012
(b) Part-time Diploma and Certificate courses
8th – 16th August, 2011
For Ph.D. courses and Short term Affiliations, applications can be made at any time of the year. For Ph.D. Courses, admissions are made in two semesters in an academic year viz. January and July. Candidates have to report in the months of July/ January for taking admissions in the respective session, subsequent to procuring the Research Visa.
For Office use only Course offered:
Course duration:
Department:
Faculty / Institute:
VISA type:
Additional Charges
VISA number
Amount:
Receipt No:
Course fee details
Issued at:
Rs./ $:
DD No.
Date:
Received by:
Receipt no.
Date:
Checked by:
Approved by:
3
on:
dated
Amount:
