Cfð ÀASÉå Application No. Affix recent passport size photograph Éà Á À ÉAUÀ¼ÀÆgÀÄ PÉÃAzÀæ «±Àé«zÁå AiÀÄzÀ ÁßvÀPÉÆÃvÀÛgÀ PÉÆà ÀÄðUÀ½UÉ Cfð APPL

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1 Cfð ÀASÉå Application No. Affix recent passport size photograph Éà Á À ÉAUÀ¼ÀÆgÀÄ PÉÃAzÀæ «±Àé«zÁå AiÀÄzÀ ÁßvÀPÉÆÃvÀÛgÀ PÉÆà ÀÄðUÀ½UÉ Cfð APPLICATION FOR POST GRADUATE COURSES OF BENGLAURU CENTRAL UNIVERSITY FOR THE YEAR ªÀÄä J Áè ÉÃrPÉUÀ½UÉ Àæ ÀPÀÛ ÀæªÀiÁt ÀvÀæUÀ¼À ÉgÀ¼ÀZÀÄÑ ÀæwUÀ¼À ÀÄß UÀwÛ ÀĪÀÅzÀÄ PHOTO COPIES of relevant certificates should be submitted for all your claims J Áè CAPÀtUÀ¼À ÀÄß vàäa ÉÃPÀÄ. ÀA AzsÀ ÀqÀzÀ CAPÀtUÀ½UÉ N. A. JAzÀÄ sàwð ªÀiÁqÀĪÀÅzÀÄ C ÀÇtðªÁzÀ CfðAiÀÄ ÀÄß wgà ÀÌj À ÁUÀĪÀÅzÀÄ All the columns should be filled. Columns not applicable should be Written as N. A. Incomplete Application is liable to be rejected 1. êÀÅ AiÀiÁªÀ PÉÆà ïðué ÀæªÉñÀ AiÀÄ ÀÄwÛÃj? To which course do you seek admission? êÀÅ E ÁߪÀÅzÁzÀgÀÆ PÉÆà ïð/péæã ïðuà½ué ÀæªÉñÀPÉÌ Cfð ºÁQ ÝÃgÁ? ºÁUÁzÀgÉà ªÀÄä DzÀåvÉ K ÀÄ? Have you applied for any other course/courses? if so, what is your order of preference? Cfð ±ÀÄ Ì ÁªÀw¹zÀ «ªÀgÀ Application fee paid details ±ÀÄ Ì Fee (in Rupees) ±ÁSÉ Branch 3. C sàåyðaiàä ºÉ ÀgÀÄ Candidate s Name ºÉ ÀgÀÄ Name E AiÀÄ ï Initial/s ÁAPÀ Date ZÀ ï ÀASÉå Challan Number 4. gá ÖçÃAiÀÄvÉ Nationality : ságàwãaiàä Indian «zéã² Foreigner C ªÁ¹ ságàwãaiàä Expatriate Indian 5. AUÀ Gender: ÀÅ: Male ¹Ûçà :Female ªÀÄAUÀ¼ÀªÀÄÄT : Transgender D D M M Y Y Y Y 6. ºÀÄnÖzÀ ÁAPÀ Date of Birth ªÀAiÀÄ ÀÄì (1 Éà dä ÉÊ 2018 ÁAPÀPÉÌ) Age (As on 1 st July 2018) 7. vá ÄAiÀÄ ºÉ ÀgÀÄ GzÉÆåÃUÀ Mother s Name Occupation vàazéaiàä ºÉ ÀgÀÄ Father s Name Or CxÀªÁ ÉÇõÀPÀgÀ ºÉ ÀgÀÄ Guardian s Name GzÉÆåÃUÀ Occupation GzÉÆåÃUÀ Occupation

2 ÉÇõÀPÀjUÉ ÃªÀÅ M â¼éã ªÀÄUÀ¼ÀÄ DVzÀÝ è, C üpàèvà ÀæªÀiÁt ÀvÀæªÀ ÀÄß UÀwÛ À ÉÃPÀÄ If you are the only Girl child of your parents?, Enclose an affidavit from the competent authority ºËzÀÄ Yes E è No 9. ªÀUÀð Category Online Scholarship (Post metric) Registration No. (for SC/ST candidates only) 10. Online Scholarship (Post metric) Registration No. (for Cat-I, IIA, IIB, IIIA, IIIB & Other Candidates excluding minorities) 11. vàazé/vá ÄAiÀÄ ªÁ ðpà ªÀgÀªÀiÁ À Father s / Mother s Annual Income Rs. 12. êÀÅ qàvà À géãsévavà PɼÀVgÀÄ«gÁ? Do you belong to Below Poverty Line Family (BPL) ºËzÀÄ Yes E è No 13. êÀÅ PÀ ÁðlPÀzÀ è K¼ÀÄ ªÀgÀĵÀ «záå sáå À ªÀiÁrgÀÄ«gÁ? Have you studied 7 years in Karnataka? ºËzÀÄ Yes E è No 14. DzsÁgï PÁqïð ÀASÉå Aadhaar Card No Éà vàgàuàwaiàä ÉÆÃAzÀt ÀASÉå SSLC/CBSE Register No. 16. ÀA ÀQð ÀĪÀ «¼Á À Address for correspondence ÀUÀgÀ City gádå State ïpéæãqï Pin Code zàægàªátâ Telephone E-ªÉÄà ï id 17. PÁ²äÃjà ªÀ ¹UÀgÉÃ? Are you a Kashmiri migrant? ºËzÀÄ Yes E è No 18. ºÉÊzÀgÁ Ázï PÀ ÁðlPÀzÀ «záåyðaiéäã? Are you a student of Hyderabad-Karnataka? ºËzÀÄ Yes E è No 19. dªàäää ªÀÄvÀÄÛ PÁ²äÃgÀ «záåyðaiéäã? Are you a student of Jammu & Kashmir State? ºËzÀÄ Yes E è No jazà 10 Éà vàgàuàwaiàäªàgéué UÁæ«ÄÃt ÀæzÉñÀzÀ è C sáå¹¹ ÝÃgÁ? Have you studied in Rural Area upto 10 th Std? ºËzÀÄ Yes E è No

3 jazà 10 Éà vàgàuàwaiàäªàgéué PÀ ÀßqÀ ªÀiÁzsÀåªÀÄzÀ è C sáå¹¹ ÝÃgÁ? Have you studied in Kannada Medium upto 10 th Std? ºËzÀÄ Yes E è No (If yes enclose a certificate ºËzÉAzÀgÉ ÀæªÀiÁt ÀvÀæ UÀwÛ¹) 22. êÀÅ ÉAUÀ¼ÀÆgÀÄ PÉÃAzÀæ / ÉAUÀ¼ÀÆgÀÄ «±Àé«zÁå AiÀÄzÀ ËPÀgÀgÀ ªÀÄUÀ ÉÃ/ ªÀÄUÀ¼ÉÃ? Are you a son/daughter of B luru Central University Employee? ºËzÀÄ Yes E è No ²PÀëPÀ Teaching ²PÀëPÉÃvÀgÀgÀÄ Non-Teaching 23. êÀÅ PɼÀPÀAqÀ AiÀiÁªÀÅzÁzÀgÀÆ P'ÉÆÃmÁ zàraiàä è ÀæªÉñÀ EaÒ ÀÄ«gÁ? Mention whether you claim any of the following quota? QæÃqÁ Sport s ÁA ÀÌöÈwPÀ Cultural J ï¹¹ NCC J ïj ïj ï NSS ÉÊ PÀgÀ ªÀÄPÀ̼ÀÄ Defence êÀÅ «PÀ ZÉÃvÀ ÀgÉ? Differently/ Visually Challenged 24. CºÀðvÁ ÀzÀ««ªÀgÀUÀ¼ÀÄ Details of qualifying examination a. ÀzÀ«Degree b. 1. ÉAUÀ¼ÀÆgÀÄ «±Àé«zÁå AiÀÄ Bangalore University 2. PÀ ÁðlPÀzÉƼÀV À EvÀgÉ «±Àé«zÁå AiÀÄ Other University within Karnataka 3. ºÉÆgÀ gádåzà «±Àé«zÁå AiÀÄ Other University Outside Karnataka 4. ÉAUÀ¼ÀÆgÀÄ «±Àé«zÁå AiÀÄzÀ ÁéAiÀÄvÀÛvÉAiÀÄ PÁ ÉÃdÄUÀ¼ÀÄ Bangalore University Autonomous Colleges c. véãuàðqéaiàiázà ªÀµÀð Year of passing d. ÉÆÃAzÀt ÀASÉå Register No. e. zàeéð Class I/II/III f. UÀjµÀ CAPÀUÀ¼ÀÄ Max. Marks g. MlÄÖ ÀqÉ gàäªà CAPÀUÀ¼ÀÄ Total Marks obtained ÀzÀ«AiÀÄ è ÀqÉ gàäªà CAPÀUÀ¼ÀÄ Marks in Degree sáµé Languages UÀjµÀ CAPÀUÀ¼ÀÄ Max. Marks ÀqÉzÀ CAPÀUÀ¼ÀÄ Marks obtained LaÒPÀ Optionals UÀjµÀ CAPÀUÀ¼ÀÄ Max.Marks ÀqÉzÀ CAPÀUÀ¼ÀÄ Marks obtained

4 25. AiÀÄĹAiÀÄ è fãªà±á ÀÛçªÀ ÀÄß N ÝÃgÁ? Have you studied Biology in Pre-University [10+2]? ºËzÀÄ Yes E è No 26. AiÀÄĹAiÀÄ è UÀtÂvÀªÀ ÀÄß N ÝÃgÁ? Have you studied Mathematics in Pre-University [10+2]? ºËzÀÄ Yes E è No êÀÅ AiÀiÁªÀÅzÁzÀgÀÆ ÁßvÀPÉÆÃvÀÛgÀ ÀzÀ«AiÀÄ è GwÛtðgÁV ÝÃgÁ? Have you passed any Postgraduate Degree? ºËzÀÄ Yes E è No 1. ÉAUÀ¼ÀÆgÀÄ «±Àé«zÁå AiÀÄ Bangalore University 2. PÀ ÁðlPÀzÉƼÀV À EvÀgÉ «±Àé«zÁå AiÀÄ Other University within Karnataka 3. ºÉÆgÀ gádåzà «±Àé«zÁå AiÀÄ Other University Outside Karnataka a. véãuàðqéaiàiázà ªÀµÀð Year of passing b. ÉÆÃAzÀt ÀASÉå Register No. c. zàeéð Class I/II/III d. UÀjµÀ CAPÀUÀ¼ÀÄ Max. Marks e. MlÄÖ ÀqÉ gàäªà CAPÀUÀ¼ÀÄ Total Marks obtained 28. véãuàðqéaiàiázà EvÀgÉ ÀjÃPÉëUÀ¼ÀÄ Other examinations passed ÁæAiÉÆÃfvÀ C sàåyðaiàiávzàýgé- ÀA ÉÜAiÀÄ ºÉ ÀgÀÄ ºÁUÀÆ ÀÆPÀÛ zár É ÀvÀæªÀ ÀÄß UÀwÛ¹ If you are a Sponsored candidate mention Organization s Name & enclose a copy of the certificate 30. EvÀgÉ ªÀiÁ»w Any other information you would like to furnish 31. ÀéAiÀÄA zàèrüãpàj À àlö MlÄÖ UÀwÛ À ÁzÀ ÀæwUÀ¼ÀÄ Total Number of enclosures attested by self

5 - 5 - C sàåyðaiàä WÉÆõÀuÉ Declaration by the Candidate Á ÀÄ ªÉÄÃ É w½¹gàäªà J Áè ªÀiÁ»wUÀ¼ÀÄ ÀvÀåªÁVgÀÄvÀÛzÉ JAzÀÄ WÉÆà ÀÄvÉÛÃ É ªÀÄvÀÄÛ AiÀiÁªÀÅzÉà ªÀiÁ»wAiÀÄ ÀÄß ªÀÄgɪÀiÁagÀĪÀÅ è. Á ÀÄ và ÀÅöà ªÀiÁ»w ÃrzÀÝ è, ÉAUÀ¼ÀÆgÀÄ PÉÃAzÀæ «±Àé«zÁå AiÀĪÀÅ, À Àß «gàäzàþ PÀæªÀÄPÉÊUÉƼÀî ºÀÄzÁVgÀÄvÀÛzÉ. I hereby declare that the above information furnished by me is true. I have not suppressed any information. Bengaluru Central University can initiate action against me, if I have furnished any false information. Application No.: ÁAPÀ Date : ÀܼÀ Place : C sàåyðaiàä À» Signature of the Applicant

6 - 6 - For Office use only Supernumerary weightage Details Weightage Awardees Name Signature Date Sports Cultural NCC NSS Defence Differently / Visually Challenged Details to be filled by the applicant and to be verified by the admission committee Sl No. Particulars 1. Whether photocopy of the SSLC Marks card enclosed Yes / No Register No. 2. Whether photocopy of the PUC Marks card enclosed Yes / No Register No. 3. Aggregate Qualifying exam Register No. % Cognate Subject Cognate Subject % 4. Whether photocopy of the Caste Certificate enclosed Yes / No If yes, which category you belong to 5. Whether photocopy of the Income Certificate enclosed 6. Whether photocopy of Aadhaar card enclosed 7. Whether registered for scholarship in Social Welfare Department previous year? (for SC/ST applicants only) 8. Whether applied for scholarship in Backward Classes welfare Department previous year? 9. Whether the candidate applied for any supernumerary quota (Sl.18 to 21) Yes / No If yes, parent s/guardian s annual income Yes / No If yes, Aadhaar Card No : If yes, mention Registration No : Yes / No If yes, mention Registration No : Yes / No Signature of the verifying official Seal & Signature of the Chairperson / Member Admission Committee

7 - 7 - UNIVERSITY S COPY Post Graduate Admission ACKNOWLEDGEMENT (To be filled by the Candidate) 1. Candidate s Name : Application No. :.. 3. Course :.. 4. Category :.. 5. Date of submission :.. Collecting Official s Signature CANDIDATE S COPY Post Graduate Admission ACKNOWLEDGEMENT (To be filled by the Candidate) 1. Candidate s Name : Application No. :.. 3. Course :.. 4. Category :.. 5. Date of submission :.. Collecting Official s Signature