Prescribed Application Form - Foreign Students
Latest
Passport size
Photograph
of student
1. BIO-DATA
Full name :
Last name Middle name First name
Date of Birth:
DD MM YY
Gender: Please check the box:
M F
Nationality:
Full postal address (with ZIP/PIN Code):
E-mail address:
Telephone Nos:
Name of the Institute/University:
Full postal address(with ZIP/PIN Code):
E-mail:
Fax No.:
Telephone No:
Name of the course being pursued:
Description of the course in brief:
Educational Qualifications:
Degree obtained Name of the Grade Year of passing
Subjects
Institute/University % of marks
Work experience, if any:
Topic of interest preferred for internship:
I certify that the above information furnished by me is true to the best of my
knowledge and belief.
Place: Signature :
Date: Name of the student:
2. Authentication of particulars furnished in (1) above by the
Institute/University
This is to certify that the information furnished by Mr./Ms./Mrs.-------------------------------
----------------- in the prescribed Application Form at (1) above is correct to the best of
our knowledge.
Recommendations, if any
Signature & Seal of
Authorised Official