Professional Documents
Culture Documents
PG
APPLICATION NUMBER
POST
GRADU
ATE COURSES - 20142015/2015
POSTGRADU
GRADUA
nr
Hf;if tpz;zg;gg; gbtk; /APPLICATION
nrHf;
FOR ADMISSION
ENROLMENT NUMBER (to be assigned by the IDE office / Co-ordinator, Spot Admission Centre)
ACADEMIC YEAR 2014-2015
REGISTRATION FEE Rs. 150/(Payment should be made either by Bank Challan / Demand Draft)
CANDIDATE TO FURNISH ALL THE REQUIRED PARTICULARS BELOW IN CAPITAL LETTERS
Candidate to tick ( ) any one of the appropriate boxes
for Tuition Fee Consession - (Refer to Page No. 18)
Differently Abled
Prison
Main Subject
Medium (Tick
TAMIL
ENGLISH
Centre
Code
Place
NAME
District
State
: INDIA
Pin code
Phone (Res)
: Off.
Recent Passport
Photograph signed by a
Gazetted Officer /
PRO/AR (IDE) /
Faculty with Seal
(a)
in English :
(b) in Tamil :
(b) Age
6. a) Community (Tick
OC
/ SC
/ BC
/ MBC
/ ST
No
5. Religion
/ Female
b) Caste
) Yes
4. Nationality
9. Present Occupation
7. Mother Tongue
Registration
Number
Class with
Grade/Marks
Maximum
Marks
UG Degree Course
Strikeout whichever is not applicable
(State Whether it is Two Years
or Three Years Course)
(The above statement must be attested by the same Gazetted Officer/Assistant Registrar/
Public Relation Officer (IDE) / Faculty who attested the Photograph)
Enclosures
(1) .......................................
(3) .................................................
(5)
..............................................
(2) .......................................
(4) ................................................. (6) ..............................................
I hereby declare that all the particulars given above are correct and I agree to abide by all the Rules and Regulations
of the University that are in force from time to time.
Station
Date
:
:
VERIFYING STAFF
SECTION OFFICER
Conduct Certificate
..............................
ASSISTANT REGISTRAR
STUDY CENTRE / SPOT ADMISSION CENTRE / PARTICIPATORY INSTITUTIONS / TWINNING PROGRAMME CENTRE / OFFICE
DIRECTOR
Received the Provisional admission intimation and all the originals submitted by me
SIGNATURE OF THE APPLICANT
WITH DATE
UNIVERSITY OF MADRAS
INSTITUTE OF DISTANCE EDUCATION
COMPUTER CODING SHEET
POSTGRADUATE COURSES 2014-2015 / 2015
1. Course to which admission is sought
M.A.
M.Music
M.Com.
M.Sc.
4. Name of the Candidate (Write in Capital Letters) (a) in English (b) in Tamil
(a)
(b)
5. Name of Father / Guardian / Husband (Write in Capital Letters)
as per entry in the Transfer Certificate
Date
Month
Year
8. Sex
7. Date of Birth
Male
Female
City
Phone
Pincode
Mobile
Indian
Others
English
Tamil
12.
Region
Urban
ST
MBC
Rural
13. Religion
14. Caste
15. Community
SC
YES
NO
YES
NO
Name
Name
Yes
BC
OC
Code No.
Code No.
Category
No
Yes
No
Differently Abled
Prison
Affix
Passport Size
Photo
Not to be attested
Station :
Date
ADDRESS SLIP
POSTGRADUATE COURSES
Academic Year 2014 - 2015
Not to be attested
Affix
Passport Size
Photo
To be filled in by the applicant (6 copies of his/her address) and returned with the completed application form
Please note that the admission intimation, original certificates and learning materials will be sent only to this address by Postal Service
Name : ............................................................................
Name : ............................................................................
...........................................................................................
...........................................................................................
Address : .........................................................................
Address : .........................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
Mob.No..............................................................................
Mob.No..............................................................................
PIN
PIN
Name : ............................................................................
Name : ............................................................................
...........................................................................................
...........................................................................................
Address : .........................................................................
Address : .........................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
Mob.No..............................................................................
Mob.No..............................................................................
PIN
PIN
Name : ............................................................................
Name : ............................................................................
...........................................................................................
...........................................................................................
Address : .........................................................................
Address : .........................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
Mob.No..............................................................................
Mob.No..............................................................................
PIN
PIN
10+2
Semester / Non-Semester
DETAILS OF THE FIRST/SECOND YEAR EXAMINATION ALREADY APPEARED & PASSED only:
Name of the
papers appeared
& passed
Code of the
subject
Reg. No.
Secured
Marks
RESULT
Passed
The above statement must be attested by the Gazetted Officer/Assistant Registrar/Public Relation Officer(IDE)/Faculty
I hereby declare that all the particulars given above are correct and I agree to abide by all the rules and regulations of
the University that are in force from time to time.
Station:
Date:
PG-Degree
1.
2.
Exemption of the following papers may be given to the candidate in which already appeared and
passed
Core Courses-Main subjects
First year
Second year :
3.
The candidate has to appear for the following papers as prescribed in the prospectus for the year
20 - 20 as per the decision of Chairman BOS
Core Courses-Main subjects
First year
Second year :
4.
Rs.500/- may be collected from the candidate towards the fee for Readmission.
5.
Rs.750/- may be collected from the candidate towards the fee for Transfer from other University.
6.
Rs.100/- may be collected from the candidate towards the fee for exemption
7.
8.
9.
Remarks if any:
Asst/ASO (Admn)
Asst/ASO(ES)
SO(ES)
Asst.Regr(Genl)
DIRECTOR
D.R.(Admn)
91
Authorised Signatory
Seal / Date
Rs.
Authorised Signatory
Rs.
Seal / Date
Tel. :
Tel. :
Rs.
I / II / III
Year
Total
Total
Convocation Fee
Convocation Fee
Examination Fee
Tuition Fee
Registration Fee
Particulars
A
B
C
Fee Code
Rs.
Course Subject
Examination Fee
Tuition Fee
Registration Fee
Particulars
I / II / III
Course of Study
A
B
C
Fee Code
Course Subject
Year
Enrl.
Number
Enrl.
Number
Course of Study
Students
Name
783493481
179101000001791
Students
Name
IOB
INDIAN
BANK
783493481
179101000001791
IOB
INDIAN
BANK
IDE COPY
UNIVERSITY OF MADRAS
INSTITUTE OF DISTANCE EDUCATION
BANK COPY
UNIVERSITY OF MADRAS
INSTITUTE OF DISTANCE EDUCATION
783493481
179101000001791
Total
Convocation Fee
Examination Fee
Tuition Fee
Registration Fee
Rs.
I / II / III
Year
Authorised Signatory
Rs.
Seal / Date
Tel. :
A
B
C
Fee Code
Particulars
Course of Study
Course Subject
Enrl.
Number
Students
Name
IOB
INDIAN
BANK
UNIVERSITY OF MADRAS
INSTITUTE OF DISTANCE EDUCATION
STUDENT COPY
92
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Institute of Distance Education
University of Madras, Chepauk,
Chennai - 600 005.
Total
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10 X
20 X
50 X
100 X
500 X
1000 X
Particulars
Rs.