BPKM’s Processing fees: Rs. 500.00/-

UKA TARSADIA UNIVERSITY (University Established Under the Gujarat Act No. 8 of 2009 Government of Gujarat)

Maliba Campus, Bardoli - Mahuva Road, Dist: Surat, Pin- 394 350. WWW.utu.ac.in Phone : 02625 – 254122

APPLICATION FOR ADMISSION TO

M.SC. CHEMISTRY PROGRAMME

(To be filled in by candidate‘s own handwriting)

Application No.: ______________

1. Organic chemistry 3. Pharmaceutical Chemistry

2. Industrial Chemistry 4. Analytical Chemistry

Preferential Selection of Subject:

A.1 NAME: Mr./Ms. ______________________________________________________________________________ (In full Block Letter) Surname Own Name Father’s/Husband’s Name

A.2 DATE OF BIRTH:

B.1 SEX: Male Female MARITAL STATUS: Married Unmarried

C.1 APPLICANT RESIDENTIAL ADDRESS: ______________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

C.2 PHONE: Residence: __________________________________ Office: ______________________________________

C.3 Mobile: ______________________________ E-mail: ___________________________________________________

C.4 PERMANENT ADDRESS:__________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

D. ACADEMIC PERFORMANCE: (Stages of Education)

Examination University/ Board

Month & year of Passing

Marks Percentage Class

Obtained Out of

S.S.C. (X)

XI

H.S.C. (XII)

F.Y

S.Y.

T.Y.

Any Other

E. NAME OF THE COLLEGE / INSTITUTE LAST ATTENDED: ______________________________________

_______________________________________________________________________________________

NOTE: Duly filled Application forms with D.D. worth Rs. 500.00 drawn in favor of “C.G. Bhakta

Institute of Biotechnology Payable at Bardoli” shall reach to Institute before last date.

F DECLARATION BY THE CANDIDATE:

1 I hereby solemnly declare that I have read all the Rules of Admission and I have consulted my parents/guardian and after fully understanding the Rules I have filled in this application.

2 The information furnished by me in this application is true of the best of my Knowledge and belief.

3 I fully understand that no other documents than those required will be entertained on priority for admission.

4 I declare that I shall abide by the instruction, Rules etc. of UTU and also the acts and laws in force.

5 I hereby undertake that I shall pursue the studies at UTU and shall not do anything inside or outside the UTU, which may result in disciplinary action against me.

6 I fully undertake that the admission to the course will be made depending on my inter-se merit and availability of a seat at the time of scrutiny of my disciplinary action against me.

7 I fully understand that the Director or the UTU or the competent authority will have full liberty to expel and/or debar me from the institute if I am proved guilty of using means during examinations.

8 I fully understand that the Director or the UTU or the competent authority will have full liberty to expel and/or debar me from the institute if a am proved guilty of using unfair means during examinations.

9 I fully understand that in case of grade and/or grade points, it is the candidate’s responsibility to convert the grade and/or grade points into the mark & submit it at the time of admission.

10 I fully understand the rules for cancellation of admission & that fee once paid will be refunded as per the rules applicable at that time.

11 I hereby agree to observe rules relating to library, computer Lab, I-card & Code of conduct.

12 I know that rounding up of the marks for calculation the percent of mark at the time of admission is not allowed.

In case of application received by hand or through courier services of any type, benefit of extended time will not be available regardless of the place of residence of the applicant, candidate should clearly note that the UTU will in no case be responsible for non – receipt of their application or any delay in receipt thereof on any account whatsoever. They should therefore, ensure that their application reaches to the Registrar on or before the prescribed last date. All the disputes are subject to Bardoli (Surat) Jurisdiction. I have checked all the entries in this application. They are true; I have kept all enclosures ready to be presented on demand if admitted. I agree comply with the rules of the institute.

I understand that & agree that, in case my present employee terminates my service in between, it will be my responsibility to address the essential requirement agreed upon at the time of admission. I have enclosed all mandatory originals & attested copies of testimonials as per the checklist. Place: ____________________

Date: _____________________ ________________________________

Signature of the applicant

FOR OFFICE USE ONLY

Please submit attested copies of following documents

Remarks

Certificate Checked:

YES NO

1. Marksheet – X / XI / XII

2. Marksheet - I / II / III (B.Sc )

Admission: Granted / Declined 3. School Leaving Certificate

4. Migration / TC Certificate

Checked by Verified by

Director (CGBIBT) Admission In charge