GEN/ SC/ ST/OBC (Please put a tick mark)

Rs. 400/- (Rs. 200/- for SC/ST)

UNIVERSITY OF KALYANI
Kalyani, West Bengal
Application for Admission to
D.Litt / D.Sc. Programme in
(Subject)

Photograph

Session: 20.
Space for Office Use

1. Name of the applicant:(Block Letters)

Surname

First name

Middle name

2. Fathers/ Guardians name: .

3. Permanent Address:
Pin : .
6. Mailing Address (Postal):
Pin : .
E-mail:.Tel. :
7. Nationality: ..
8. Date of Birth( According to School Leaving Certificate:

/ .. /
Day
Month
Year

9. (a) Academic Qualifications:

Degree

Name of the University/ Institution

Year of passing/awarded

Masters
Ph.D.
Others

10. Ph.D thesis title:

11. Research Experience:

a) Number of years:
b) Number of Research Papers published in ISSN/refereed journals:
c) Number of Research papers published in the area of the proposed
D.Litt/D.Sc. work:
d) Number of Books published:
e) Number of articles/chapters in Books:
e) Number of citations received supported by Google Scholar/SCOPUS profile:

% of marks

f) Number of Ph.D. students supervised/supervising:

( Please enclose detailed list of publications with bibliometric indicator (impact factor, H-index)
along with a copy of each publication. Please use additional sheets.)

12. Title of Research Proposal for D.Litt/D.Sc. program*:

(* Enclose a copy of the summary of the research proposal)

13. Application Fee (Challan copy to be attached)

Please note the application should be accompanied by:
i. Attested copies of mark-sheets, diplomas and certificates obtained by the candidate in the past.
ii. Summary of the Ph.D. thesis.
iii. SC/ST/OBC candidates must submit copy of certificate.
iv. No objection certificate from the employer.
*Candidates are requested to read the University Regulations for M.Phil and Doctoral Degrees before
applying.
(Print the Application Form using Legal-sized paper)

DECLARATION: I solemnly declare that the particulars and information supplied above are correct to the
best of my knowledge and belief. I also promise that I will not indulge in any such activity, misbehavior or
violence of any sort that will bring disrepute to the University. In case I am found involved in any such act, my
admission should be withdrawn immediately and I should be subjected to any punishment that the University
Authorities deems fit.

Date:

Signature of the candidate in full

Place:

________________________________________________________
RECEIPT
UNIVERSITY OF KALYANI
Received the filled-in application form from Smt/Sri
for the D.Litt/D.Sc. Course in .. .

Signature of Official with date & stamp

ADMISSION SECTION
P.O-KALYANI,DIST-NADIA,PIN741235,W.B

APPLICANT'S COPY
SBI Powerjyoti Account
Note: Fees collection Charges is to be paid additionally

Fee Payment Challan

Fee Collection Account Number
32183583982
State Bank of India
Branch Name
Branch Code
Date

Applicant's Name
Address & Mobile
No.

Application fees
Fee collection
charges
Total
Amount in words....

only
Signature of the Applicant
For Bank use only
Journal No.
Seal /Date

Authorized Signatory

UNIVERSITY OF KALYANI
ADMISSION SECTION
P.O-KALYANI,DIST-NADIA,PIN741235,W.B

COPY TO BE SUBMITTED WITH APPLICATION FORM

SBI Powerjyoti Account

Note: Fees collection Charges is to be paid additionally

Fee Payment Challan

Fee Collection Account Number
32183583982
State Bank of India
Branch Name
Branch Code
Date

Applicant's Name
Address & Mobile
No.

Application fees
Fee collection
charges
Total
Amount in words....

.only
Signature of the Applicant
For Bank use only
Journal No.
Seal /Date

Authorized Signatory

Third Copy

UNIVERSITY OF KALYANI

Second Copy

First Copy

UNIVERSITY OF KALYANI
ADMISSION SECTION
P.O-KALYANI,DIST-NADIA,PIN741235,W.B

BANK COPY
SBI Powerjyoti Account
Note: Fees collection Charges is to be paid additionally

Fee Payment Challan

Fee Collection Account Number
32183583982
State Bank of India
Branch Name
Branch Code
Date

Applicant's Name
Address & Mobile
No.

Application fees
Fee collection
charges
Total
Amount in words....

only
Signature of the Applicant
For Bank use only
Journal No.
Seal /Date

Authorized Signatory