13. Details of Qualifications (Attach Attested Transcript of Grades / Marks Secured)@ Examination Stream Board/ Details of School/Institute/College Year of % of Marks

(See Eligibility Document) University Name State City Passing or CGPA

10th XXXXX

12th

Bachelor’s#

Master’s#

Any Other#

@ Science/Commerce/Arts/ECE/CSE/EE/Bio etc. # B.Tech/BE/B.Sc (Engg)/M.Tech/ME/M.Sc (Engg)/BA/MA/B.Com/M.Com/B.Sc/M.Sc etc.

1. Proposed Area of Work (Not more than 50 words)

2. Full Name

3. Father’s Name

4. Mother’s Name

5. Gender (M/F/TG) 6. Date of Birth 7. Person with disability (Y/N) D D M M Y Y Y Y

8. Religion (i.e. Hindu/Muslim/Sikh/Jain/Christian/Other) 9. AADHAAR NO.

10. Mailing Address

State Pin

11. Tele No. (Land Line) Mob

12. E-Mail ID

Application No. Ph.D/EVEN/2020/..................................

Paste Recent Passport Size

Photo

P.T.O.

PLEASE FILL DETAILS IN CAPITAL LETTERS ONLY

Programs :- Biotech, CSE, ECE, Humanities & Social Sciences, Physics & Materials Science and Engineering, Mathematics and Management

Note: Attach DD of Rs. 1000/-, in favour of Jaypee Institute of Information Technology, Payable at Noida/Delhi along with the application (In case not applied online).

Category (Tick ) Full Time Part Time# Sponsored@

# See eligibility and applicability in PH.D ordinance at www.jiit.ac.in. @Attach separate certificate from current employer as per Annexure-I.

Please Write Choice of Program

PHD. ADMISSION APPLICATION FORM - 2019-20

JAYPEE INSTITUTE OF INFORMATION TECHNOLOGY A-10, Sector-62, Noida-201309

(Declared Deemed to be University u/s 3 of the UGC Act, 1956)

16. Project/Thesis details along with level as applicable

14. Result of National level Exams (like NET/SLET/UGC/CSIR(JRF) and attach copy of result card (Exemption from written test shall only be given if the candidate provides the proof for above exams).

15. Work Experience (if any)

Sr. No. Designation Company / Institute Duration

17. Publications, if any (Attach separate sheet if required)

Important Notes:

l Please see website for Syllabus & Format for PhD Entrance Exam. www.jiit.ac.in

l Application status and exam instructions including admit card shall be displayed on the website.

Attachments:

l Attach a bank draft of Rs. 1000/- with downloaded application. No Additional charges in case of online or purchased application. Draft to be made in favor of “Jaypee Institute of Information Technology” payable at Noida/Delhi.

l Attach attested Transcript / Grades / Marks Secured in support of qualification as per serial 13 of application form.

l Paste one photograph on application form.

Declaration by the Student:I, hereby declare that all the particulars stated in this application form are true to the best of my knowledge and belief. I have read the Information Brochure and the Admission procedure and I shall abide by them. In the event of suppression or distortion of any fact like date of birth, nationality, category, qualification etc. made in my application form, I understand that I will be denied the opportunity to be admitted to JIIT and if already admitted, my admission would stand cancelled. I also understand that the decision of JIIT regarding my admission will be final and binding to me. I am aware of University approach toward ragging and the punishment to which I am liable if found guilty of ragging.

DATE.............................

PLACE............................ SIGNATURE...........................................