Jalandhar-Kapurthala Highway, Kapurthala-144601. Ph; 01822-662558 APPLICATION FOR ENROLMENT / REGISTRATION IN Ph.D.

DEGREE [To be submitted to the Dean (RIC)]

(Please read Ph.D. Regulations carefully, before filling the Application Form)

Regn. No.
(for Office Use Only)

Note: 1. Write Not Applicable if necessary, Dont leave any column blank. Cutting / overwriting is not allowed. 2. Provisional Registration Form should be duly typed. Manually filled Provisional Registration Form will not be accepted.

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Application Id Number Name (in Bold Capital Letters): Date of Birth Fathers Name (in Bold Capital Letters): Mothers Name (in Bold Capital Letters): Stream: (Engg./Mgt./Pharm./App.Sci. etc.) Discipline: Area of proposed research work: Topic of Thesis (tentative topic to be
mentioned, for sub allotment)

Date of submission of this application: Date of declaration of result for eligibility for registration: (Valid for 2 yrs.) Internal / External Candidate: Address of the present employer: Present Address for Correspondence:

14. Telephone No. Permanent Home Address: 15. 16. 17. 18. 19. 20. Telephone No. E-mail I.D. Name, Designation, Field & Address of the Supervisor:
(Attach Certificate from Supervisor)

Name, Designation, Field & Address of the co-supervisor (if, any)

(Attach Certificate from Co-Supervisor)

Deptt. of Univ./approved centre, where research work to be carried: Collaboration with any other Institute

21. ACADEMIC RECORD: The details of all the examinations starting with graduation. Sr. Pass-out Examination Institution / University No. Year
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Subject(s)

%age of marks

Note: Self attested copies of documents must be attached with the application form.

Published Work 22. If yes, the details including the title, the 23. 24. 25. Academic Awards / Distinctions
(Separate sheet may be attached) authors, journal/publisher, year of publication be given on a separate sheet

YES/NO

Teaching Experience
(Separate Sheet may be attached)

How long have you been working on this research problem? Migration Certificate* 26. Attached / Not Attached Amount: 27. Details of Registration Fee University Receipt No.: Date:
* If the applicant is not registered with PTU, a Migration Certificate from the previous University must be attached.
DECLARATION BY THE CANDIDATE: I hereby declare that: a) The information given above is correct and nothing has been concealed thereof. b) I am neither registered/working/studying for another degree nor shall I do so during the entire registration period. c) I have read the Ph.D. Regulations of this University and hereby agree to abide by them. d) I assure all the dues will be deposited in time with the University and a photo copy of receipt will be submitted in the office of Dean (Research, Innovation and Consultancy). Place: Date: Place: Date: Signature of Head of Institute (with seal) where working Signature of the Candidate

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Recommendations of the Supervisor(s): I/We agree to guide in the area of research as mentioned above.
A. Guide

S/o

1 2 3 4 5

Name (with Supervisor ID) Designation Address Telephone No. E-Mail I.D.

Date: Signature of Supervisor B. Co-Guide (if any) 1 2 3 4 5 Name Designation Address Telephone No. E-Mail I.D.

Date: Signature of Co-Supervisor Justification for having Co-Supervisor for research work guidance: (to be provided by supervisor)

(Separate sheet may be attached, if required)

Signature of Supervisor List of Documents to be Attached with Registration Form (Check List )

(i) Registration Fee Slip. (ii) Self-attested copy of Result of eligibility for enrolment. (iii) Certificate from Guide and that from Co-Guide (if any). (iv) Original Migration Certificate. (v) Self-attested copies of academic certificates. (vi) Self-attested copy of experience certificate(s). (vii) List of Publications (if any). (viii) Self-attested copies of Academic Awards / Distinction. (if any) (ix) Annexure-A

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