2024-25 For Office Use Only Application no. IC/Adm.
2024-25/
International Centre
Application Form for NRI/OCI/PIO/Foreign Nationals for the Session 2024 - 2025
COURSE APPLIED FOR
(UG / PG/ Ph.D./ Diploma / Certificate
Processing Fee* Details Name of Bank Bank Tr. No. Date Amount
*Processing fee: INR. 3000/- for students of SAARC countries & INR. 6000/- for students of non-SAARC countries through transfer
electronically in INR. to Account No.: 10654904247, Account Name: Special Fund (IFSC code: SBIN0000211) and attach receipt.
Section I. Personal Details
Sex M✔ F
Name of Candidate Mr. /Ms. MD ASHIKUR RAHMAN
(use block letters):
Married / Unmarried ✔
Date of Birth: 08/11/2003 Nationality: BANGLADESHI Name of Spouse:
Passport no./ DHAKA
Citizenship no. (for Nepal/Bhutan): A12840691 Place of Issue:
Date of Country of residence BANGLADESH
Date of Issue: 25/10/2023 Expiration:
24/10/2033
☐FN ☐NRI ☐OCI/PIO ☐Child of Indian worker in Gulf or SEAC** (please enclose details)
Section II. Family Details
Father’s Name: MUHAMMED NURUL AMIN Nationality: BANGLADESHI
Mother’s Name: MOST DELROBA KHANOM ROTNA Nationality: BANGLADESHI
KANDUGHAR, BRAHMANPARA, SAITSHALA - 3526, CUMILLA
Address for correspondence
(use block letters):
PIN / ZIP 3526 Phone + Mobile +8801608607342
Permanent Address KANDUGHAR, BRAHMANPARA, SAITSHALA - 3526, CUMILLA
(use block letters):
PIN / ZIP
3526 Phone + Mobile +8801608607342
Section III. Qualifying Examination Details as per your specific Course Information Brochure
☐ I have examined the relevant course, eligibility requirements and duration of course from the Information Bulletin 2024-25
www.bhuonline.in
Name of the Examination HIGHER SECONDARY SCHOOL
Grade / % of marks: 90%
(last course attend): CERTIFICATE
BANGLA
Examining Board / University: CUMILLA Language of Instruction:
Instructions
1. This application form is valid only for the academic session 2024-2025.
2. This form must be signed by the applicant in original.
3. Incomplete forms are not accepted.
4. Request for change of Course / Subject is not permitted after application is submitted.
5. Application Fee is non-refundable.
6. Details of application processing fee must be attached to application form at the time of
submission. Signature of the Candidate
** South East Asian Countries
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Section IV. Educational Details
MUST attach certified copies of all mark sheets/grade sheets and certificates.
If originals are not in English, then English version of all documents should also be attached after certification by competent authority.
Grade Conversion Formula from the Institution is required if marks are not awarded as percentage.
Examination Passed Name of Year of Marks Medium of Subjects
University/Institution passing Obtained Max. % age Instruction/
Teaching
KANDUGHAR B. B. S. 2020 4.72 5.00 75% BANGLA Bangla, Mathematics, English,
Bangladesh And Global Studies,
10th Level/ or its HIGH SCHOOL Islam And Moral Education
equivalent Physics, Chemistry, Biology,
Higher Mathematics, Information
and Communication Technology
MOSHARROF HOSSAIN 2022 5.00 5.00 90% BANGLA Bangla, English, Physics,
10 + 2 Level/ or its KHAN CHOWDHURY Chemistry, Biology, Higher
DEGREE COLLEGE
equivalent Mathematics, Information and
Communication Technology
Bachelor Degree
Master Degree
Any Other Degree
Section V. Other Details
Mother Tongue: Languages Known: ENGLI
Bangla SH
Knowledge of English: ✔ ✔ ✔
(attach Certificate of Proficiency in Read: Good / Fair / Poor Write: Good / Fair /Poor Speak: Good / Fair / Poor
English)
Have you previously studied or Course: Period:
been admitted to BHU: Yes / No ✔
Result: Passed / Failed / Enrollment no.
Other (specify details):
Whether currently studying in BHU: Course: Faculty:
Yes / No ✔
Present Occupation/Employment, if any: (Please attach a certificate from Employer)
Organization & Address Position Period Nature of duties Salary per month*
*equivalent to INR
Section VI. Additional Information if Seeking Admission for Ph.D. Course
(Application must be routed through the respective Embassies/Mission in India)
Topic of Proposed Research
(Please attach synopsis)
Research Publications (attach details) No. of Publications National International
Professional Experience (attach details) Period: Institution
Note: Candidates shall be considered for admission to Ph.D. Courses at BHU subject to fulfilling all
eligibility (including English Proficiency Certificate of TOEFL with minimum 70 score or IELTS with
minimum 6 bands or the English proficiency test conducted by the University. However, if medium of
instruction of qualifying examination in English, then this condition does not apply. Also, the candidates
should ensure that the degree possessed by them entitles them for enrolment / admission to the Ph.D.
Courses in their own countries as well.
DECLARATION
With my signature, I hereby certify that
1. The particulars given in this application form are true and authentic to the best of my knowledge and belief.
2. I have read and understood the instructions, and I accept the terms and condition of application.
3. I intend to return to my native country after completion of the course.
4. In the event of my admission to the University, I shall pay the required fees and charges in time as outlined and that I will
not ask for any financial assistance to BHU or waiver in fee/charges during the tenure of my study.
5. I will abide by the rules, regulations and policies of the Government of India and Banaras Hindu University.
6. I accept that Banaras Hindu University has the right to reject my candidature and cancel my admission at any time, if any
information is found false / fake / wrong at any stage and also if I do not follow the rules and regulations applicable from
time to time.
Date: _07/06/2024__________
Place: _DHAKA, BANGLADESH SIGNATURE OF THE CANDIDATE
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CHECKLIST for Enclosures along with Application Form (Put mark)
✔ I have checked the Eligibility Criteria for admission to the course to which I have applied.
✔ All columns are correctly filled in this application form.
✔ Application form has been signed on lower right corner of both pages AND across photograph.
✔ Grade Conversion Formula from the Institution is attached, if marks are not awarded as percentage.
✔ English version of all Certificates and documents are certified by a competent authority and are attached.
✔ Certificate of Proficiency in English from the Institute last attended (For Ph.D.: TOEFL or IELTS) attached.
✔ Processing fee is attached as transfer electronically in INR. to Account no.: 10654904247, Account Name:
Special Fund and receipt attached.
✔ Photocopies of Passport Identification Page and Visa are attached.
✔ Photocopies of Certificate for Proof of Age and Qualifications attached.
For PhD students only: An official document must be attached stating that the degree possessed by the
candidate entitles enrolment / admission to Ph.D. Course in his/her own country.
Candidates from Iran are required to submit the No Objection Certificate issued by the Embassy of Islamic
Republic of Iran in India for granting admission in the University.
SIGNATURE OF THE CANDIDATE
Applications for Ph.D. Course and Short-Term Affiliations can be made at any time of the year. Admission to Ph.D. Course is
done twice in an academic year: January and July. Accordingly, candidates are required to report in the month required for
admission counseling by the respective Faculty.
N.B.: For eligibility requirements, and degree or examination equivalence requirements, please refer to the UET/ PET/ SPECIAL
COURSES STUDY / RET Information Brochures and Ph.D. Ordinances on the BHU website, www.bhu.ac.in and
www.bhuonline.in
For Office use only
Course offered: Course duration:
Department: Faculty / Institute:
VISA type: VISA number Issued at: on:
Development Fee Amount: INR. Rs. DD No. dated
Receipt No: Date: Received by:
Course fee Details Receipt no. Date: Amount:
Checked by: Approved by:
Scanned copy of Application form along with the required documents should be
sent on email [email protected] or submit completed Application form to:
International Centre, C/3/3, Tagore House, Banaras Hindu University,
Varanasi- 221005 (U.P.), India.
Mobile No: +91-9453048443
