20112013

TATA INSTITUTE OF SOCIAL SCIENCES

(A Deemed University)
V.N. Purav Marg, Deonar, Mumbai-400 088
PLEASE USE SEPARATE D.A.F. FOR EACH PROGRAMME
Paste one recent
PASSPORT SIZE
photograph here
with your
signature on it for
identification

Detailed Application Form (DAF) for

DS

CL

HE

HO

WS

HR

PHHP

GL

SE

PHSE

SW

DA

RD

HP

DM

MC

(Please Tick off the course that you have qualified for)

All entries in the Application Form should be written in CAPITAL LETTERS. Incomplete application forms will not be accepted.
Please use additional sheets, wherever required.
Registration No.

Date of GD / PI

03

1.

Full Name: Dr./Mr./Ms. ________________________________________________________________________________

(Students Name)

2.

11

Category you belong to:

SC

ST

OBC

(Last Name)

KM

PWD

GN

Specify the Caste, if you belong to SC/ST/OBC: __________________________________________________________

3.

Date of Birth:
Date

Month

Year

3.1

Age as on June 15, 2011. __________________Years.

4.

Marital Status:

5.

Residential Address __________________________________________________________________________________

Single

Married

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
(Pin Code)

(State)

___________________________________________________________________________________________________
(Telephone No. with STD Code)

6.

(Cell No.)

(E-mail)

State of Original Domicile: ____________________________________________________________________________

4th year

3rd year

2nd year

1st year

3rd year

2nd year

1st year

2 years ( )

1 year ( )

10 years ( )

7.1

Board/University

Name of Institution Attended

From
(Month
and
Year)

To
(Month
and
Year)

Attended
Year of
Passing

Major Subjects
Studied

Total Marks
Obtained in all
Subjects including
Languages/Major
(Main)/Subsidiary
Subjects, etc.

From

Period unaccounted
To

How was this time spent?

Explain any unaccounted period from the date of passing school (S.S.C. or equivalent examination) to the date of this application

Other degrees/diplomas
(Specify...................................)

Diploma in PGDHR

(Specify...................................)

Other Masters Degree

M.Com.

M.Sc.

M.A.

B.E./B.Tech.
B. Architect
M.B.B.S.
B.D.S.
B.H.M.S.
B.A.M.S.

B.A.
B.Sc.
B.Com.
B.M.S.
B.B.S.

Higher Secondary,
Pre-University or
Intermediate

S.S.C. or its
equivalent

Duration
of Study
(in Years)
(Put Tick
Mark in the
Relevant
Box)

State particulars of your education beginning with S.S.C. or equivalent examination. Attach photocopies of all the marksheets.

Name of
Examination

7.
Out of
Maximum
Marks

Overall
Percentage
of Marks
OR
Average Grade
Point Obtained

8.

Have you taken part in NSS activities?

Family Background: (Members who are alive only father & mother Brother, if dependant on him)

Name of Family
Member

Relationship, i.e.,
Father/Mother, etc.

Yes No

Educational
Qualification

Occupation

Monthly
Income
Rs.

Any
Additional
Information

(i)

(ii)

(iii)

10.

Have you qualified for GD/PI of any other Masters Degree programme(s) at this Institute, in 201113?

Yes No

If yes, specify the name of the programme(s):

(a) __________________________________________________________________________________________________
(b) __________________________________________________________________________________________________

11.

(a) Have you appeared for any examination conducted by any other University/Institute?

Yes

No

(b) If yes, please specify the details.____________________________________________________________________

___________________________________________________________________________________________________
12.

Write your Biographical Sketch (not exceeding 250 words). The sketch is important as it enables the
Interview Panel to assess your interests. Please use separate sheet, if necessary.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
3

13.

Why are you interested in pursuing this course? Please add pages, if necessary.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

14.

Mention any work done by you relevant to the field of study selected by you.
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

15.

Which languages do you know? Please mention your proficiency as Good or Fair or Poor
Language

Speak

Read

Write

1. English

2.
3.

16.

Please indicate how you will meet your expenses during the period of study.
Source of Funds
Name

Relationship

(i)

(ii)

(iii)

Amount Expected,

Period for which

Per Month

it is Assured

17.

Are you employed? If yes, please give the following details of your past and present job(s).

Name of Employer and Place of Work

Designation and Nature of Work

Years of
Service

Gross/Consolidated/
Monthly Salary Drawn

(i)

(ii)
(iii)

18.

If you are employed, how will you ensure attending classes and also field work (Please tick any one of the followings).
Your employer will grant you study leave/duty leave for these periods.
You will use your personal leave/vacation slots to attend classes in these period.
You will have to lose pay for these periods.
It will pose difficulty and you have not yet worked out how to manage this.

19.

Declaration by the Applicant

I hereby certify that the information provided in the Application and Detailed Application Form is complete and
accurate. I have not been disqualified by any university or other institution from appearing for any examination or from
seeking admission for any programme of study.
I will be appearing for final year examination of my Bachelors Degree under _______________________________
(If it is applicable)
(specify the pattern of study)
(10+2+3 OR 10+2+2+1)
I agree that the Institute has the right to cancel my admission and/or withdraw the Degree awarded to me if the
Institute finds that the information in this application is incorrect and/or misleading at any point of time. I also agree that on
being admitted, I shall abide by the rules of attendance requirements, discipline, conduct, hostel, etc., of the Institute and
any modification to the rules, as may be made from time to time, after my admission.

(Place)

(Date)

(Signature of applicant)

IMPORTANT
(i)

A set of photocopies of all the relevant marksheets and certificates as mentioned at the end of this form must
be attached with this Form.

(ii)

Verification of original marksheets/certificates, etc., will be done after the announcement of the admission
results, i.e., between April 22 and May 07, 2011.

(iii)

Admission will be confirmed subject to the verification of original certificates, marksheets and eligibility fulfilment
of the selected candidates.
5

List of Enclosures: (photocopy only)

1. 10th Std. Marksheet

Yes

No

2. 12th Std. Marksheet

Yes

No

3. First Year Degree Marksheet

Yes

No

4. Second Year Degree Marksheet

Yes

No

5. Third Year Degree Marksheet (If graduate completed)

Yes

No NA

6. Fourth Year Degree Marksheet (If it is four years degree)

Yes

No NA

7. Caste Certificate (for SC/ST/OBC candidates only)

Yes

No NA

8. Latest Non-creamy Layer Certificate (for OBC Candidates only)*

Yes

No NA

9. Income Certificate, 20092010 (for SC/ST/OBC Candidates only)

Yes

No NA

10. Work Experience Certificate, if any

Yes

No NA

11. Biograpahical sketch, written/typed, in a plain paper (compulsory)

Yes

No

12. Any other certificates relevant to the course, like PG Degree/Diploma

Yes

No NA

13. Internship completion certificate (For medical graduates)

Yes

No NA

14. Post-graduate statement of marks

Yes

No NA

This application, along with enclosures, should be sent through Speed Post / Registered Post only, superscribing on the
envelope DAF for ___________________ Course, Date of GD/PI __________________, by February 22, 2011 to:

Section Officer (Admission)

Tata Institute of Social Sciences
V.N Purav Marg, Deonar
Mumbai 400 088

* Candidates belonging to OBC category who do not possess the NON-CREAMY LAYER (STATUS) Certificate will be
treated as General candidates and their final selection will be done along with other general candidates and no extension
of period will be granted to get it from competent authorities.