Shivaji University, Kolhapur
Application form for a Admission to Ph.D. Course
Under the Faculty of Commerce
To, The Director, Online Application No. Board of College & University Development Shivaji University,Vidyanagar, 4438 Kolhapur-416004 Sir, I hereby apply for admission to the degree course in () of the Shivaji University,Kolhapur. I have not been admitted as a student to any other fulltime regular course in this or in any other university. I give below the particulars as required by the University Rules.
Affix ICard Size Photograph here.
Faculty : Commerce Name of Candidate :CHIMMAD PRABHUDEVA Fathers / Husbands Name : SANGAPPA Present Address :A 5 ANAND APARTMENTS SADASHIV NAGAR BELGAUM KARNATAKA Ph. No : 08312474292
Subject : Business Management
Mothers Name :MAHADEVI PermanentA 5 ANAND APARTMENTS Address :SADASHIV NAGAR BELGAUM KARNATAKA email :
[email protected]
Mobile : 9886631378
Present LECTURER/AITM BELGAUM/MBA Occupation : Teaching Exp. :at Jr College.: Date of Birth :07/03/1981 Cast : NT(B) 0 Years 0 Months at Sr College.: 1 Years 0 Months Gender : Male Physically No Handicapped : Marital Status : Unmarried Nationality : Indian
Up to date details of Academic achievement(Beginning with last degree)
Sr. Name of College / Institute 1 KLS IMER BELGAUM 2 KLECET BELGAUM 3 VIVEKANAND COLLEGE KOLHAPUR 4 NMES KOLHAPUR 5 Name of Board / University KARNATAK UNIVERSITY VTU BELGAUM Examination MBA BE Year of Passing 2007 2004 1998 1996 Roll / Seat No MBA0500 3056 2KL98IP0 24 J011915 F087233 Class & Percentage 61.84 70.34 60.5 64 Subject Offered MARKETING INDUSTRIAL PRODUCTION SCIENCE SCIENCE
MSBSHSE KOLHAPUR HSC MSBSHSE PUNE SSC
Payment of Fees
Amount 850 DD No 944709 Issue date 14/05/2012 Issuing Bank Name & Code SYNDICATE BANK / 0503
Declaration
I have carefully read the instructions and particulars supplied to me. I declare that the entries made in this application form are true to the best of my knowledge and belief. Place: Date (DD/MM/YYYY): Signature of Candidate
Please confirm following things before submitting the application form 1) Attested copies of mark list are to be enclosed 2) A Demand Draft(D.D.) / Cash challan is attached with application form. Name & Application form number is mentioned behind D.D.(D.D. should of any nationalize bank & drawn in favour of "Finance and Accounts Officer, Shivaji University,Kolhapur", payable at kolhapur. Student can get cash challan at cash section [Room No 107 at University office] if he / she is submitting application form personally)