1 N NA AT TI IO ON NA AL L I IN NS ST TI IT TU UT TE E O OF F T TE EC CH HN NO OL LO OG GY Y K KA AR RN NA AT TA AK KA A, , S SU UR RA AT TH HK KA AL L P.O. SRINIVASNAGAR, MANGALORE-575 025Regis!"i#$ N#. (for office use only) Admission to M.Sc. (Physics) Programme 2015-16 Instructions: 1.Fill your address in the address slips supplied and Registration Memo supplied. 2.Enclose self attested photo copies of marks card and other documents. 3.Candidates are appearing for the final degree exam of May/ June 2015 may also apply provided they can produce proof of their eligibilityfor admission by September 15, 2015. 4.Late/incomplete/Applications without DD are liable to be rejected. 5. Last date for submission of filled in application is 15.05.2015. 1.Name of the Candidate in full (in Block Letters as mentioned in the Degree Certificate): 2.Address of the applicant (with pin code): a.Permanent: b.Correspondence c.Telephone with STD Code or contact number/ Mobile No.: d.Email (if any): 3. Name and address of Father/Mother (or Guardian if the parents are not alive, state relationship of Guardian) 4.Occupation of Father/Mother/Guardian Annual Income Affix recent Passport size photo to be with self attestation Particulars of D.D. drawn Name of the issuing Bank ______________________________ Drawn at ____________________________________________ D.D. No. ____________________ dated ___________________ Rs. _______________ Category: OC / SC / ST / OBC / PWD (Tick mark the appropriate) 2 5.a. Religion of the Candidate:. Caste/Subcaste . b. Do you belong to Scheduled Caste/Tribe/OBC(Tick Mark)Yes / NoSC / ST / OBC If yes, enclose a copy of the Caste Certificate fromCompetent Authority c.Place of domicile d.Nationalitye.Do you belong to Persons with Disabilities (PWD) group? Yes / No (if yes, enclose copy of certificate issued by the Competent Authority) f.Are you a Sponsored Candidate? Yes / No (If yes, forward your applications through proper channel) 6. Date of Birth (Copy of the Supporting document to be enclosed) In Figures: In Words: 7.Academic Record:

a. i.Qualifying Degree Examination Passed : ii.Institute where he/she studied : iii. Period of study :from __________________to ________________ iv. University: b.Marks obtained in the Qualifying Examination (Bachelors Degree): Year of PassingMarks obtainedMax. MarksPercentage Class/ Division I Year I Sem. II Sem. II Year III Sem. IV Sem. III Year V Sem. VI Sem. 8.Details of Practical Training under gone, if any, other than that required for graduate Course. Attach extra sheet if necessary. 3 9. DECLARATION OF CANDIDATE Iherebydeclare that to the best of my knowledge,theparticulars furnished in this application are correct. I am willing to forfeit the seat secured, if any information provided by me is false. Ifselectedforadmission,IundertaketoabidebytheregulationsofadmissionandRulesoftheInstitute,andthe Academic Regulations that govern the programme of study. Place: Date:Signature of candidate Documents (photo copies) to be enclosed. 1.Copy of the Marks Card of Qualifying Exam (all years- all semesters) 2.S.S.L.C./ X Std. Marks Card (for date of birth). 3.Caste Certificate issued by Competent authority for SC/ST. 4.Persons With Disabilities (PWD) Certificate, if applicable. 5.OBC Certificate in the Central Govt. format issued by competent authority in case of OBC. 6.Sponsorship Certificate (if sponsored)7.Two Self-Addressed Envelopes with Stamp each worth Rs 17/- (For postage in Mangalore) / Rs 39/- (for Postage outside Mangalore). 10.FOR USE BY FORWARDING AUTHORITY (EMPLOYER) Sponsorship (Deputation) Certificate/ Theapplicant(name).hasbeenapermanentstaffof thisInstitute/Organizationfrom..andhas..yearsofexperience (teaching/R&D/industry). 1.Sponsorship/ (Deputation) certificate: He / She is sponsored (deputed) with full/half/no salary (Strike-out whichever is not applicable), for full time study in National Institute of Technology Karnataka, Surathkal. 2.Thecandidateandhis/hersponsorship(deputation)/NOCwillnotbewithdrawnbeforethecompletionof the course/programme. Office Seal Station:Signature of the Employer

Date:Name: Designation: (Note:Sponsorshipcertificateshouldbesubmittedinthesameformatasindicatedinthisapplicationform duly signed by the Employer/ Sponsoring Institute Head and seal.) 4 NATIONAL INSTITUTE OF TECHNOLOGY KARNATAKASURATHKAL, POST SRINIVASNAGAR, MANGALORE- 575025, KARNATAKA STATE. REGISTRATION MEMO. Date:......... 2015 Ref:Application for admission to M.Sc.(Physics) Programme TheRegistrationNo.assignedtoyourapplicationforadmissionisnotedbelow,whichmustbequotedinall correspondencesconnectedwithyourapplication.Nonoticewillbetakenofanycommunicationordocumentsentbyyou unless it bears your Registration Number. Registration Number: M.Sc.(Physics)........../2015-2016Asst. Registrar (Academic)

To: The Asst. Registrar (Academic),Mr./Ms. ________________________ N.I.T.K., Surathkal ______________________________

Post Srinivasnagar_______________________________

MANGALORE - 575 025._____________________________ AffixStamp Rs.6/- 5 (Write address of the candidate) To To:__________________________________________________________

__________________________________________________________ __________________________________________________________ __________________________________________________________ Pin Code ________ (__________State) Pin Code ___________ (________State) To To:__________________________________________________________

__________________________________________________________ __________________________________________________________ __________________________________________________________

Pin Code _________ (__________State) Pin Code __________(__________State) 6 APPLICATION FOR M.Sc.(Physics) BY REGISTERED POST ADMISSION 2015 From: To: ____________________________The Asst. Registrar (Academic), ____________________________N.I.T.K., Surathkal ____________________________ Post Srinivasnagar ____________________________MANGALORE - 575 025. ____________________________