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SCHOOL OF DISTANCE EDUCATIONAndhra Un iversi ty, Visakhapatnam - 530 003

APPLICATION FOR ADMISSION INTO ....................................................................

(Please specify the Course) :

N.B. 1. To be filled-in by the candidate2. Tick ( ) in relevant box ( ) where necessary

Last date for receipt of fi lled-in application is :

Admission Application For Post - Graduate CoursesCode No.

(For Office Use only)

1. Name of the Candidate (in Block letters) (As per Degree Certficiate)

Name Surname

Date Month Year

2. Date In figures :ofBirth In words :

3. Place State DistrictofBirth

4. Identification Marks :

1.

2.

4a. Name of the Father / Guardian :

5. Permanent Address Postal Address

6. Personal Particulars : Male Female Married Unmarried

7. Nationality : Religion :

8. Caste, Specify if : SC ST BC-A BC-B BC-C BC-D

9. Name, occupation, address and income ofParent/Guardian, state relationship

10. Particulars of the fee paid :

Amount in Rs. D.D.No. / Challan No. :

Place : Date :

RECEIVED ORIGINALS : ........................................

Sl. No.

AffixRecent

Passport sizePhotograph

Here

Phone / Cell No : e-mail Id:

Downloaded application should be sent along with a DD for Rs.40/- together with admission fee

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11. If candidate is employed : (V) Name and Address of the employer :

(i) Designation :

(ii) Total Salary :

(iii) Total service to date :

12. Particulars of qualifying examinations

Name of the Year and Name of the Regular/ Reg. No.Examination Month of University/ Private

Passing Board

A. Details of II Language Group Subjects Class obtained % of marksqualifyingexaminationpassed

B. Details of Name of Year(s) of Reg.Optionals/subjects

any other Examination(s) Passing No.(s)examination(s)passed

C. Name and address of the Date of Institution last studied Admission :

Date ofLeaving :

13. Optional Paper which you propose to take in respect of the following courses. (Please tick the relevantbox) See the Prospectus for further details regarding the Optional Papers Offered.

a) M.Com. : The candidate has to choose either of the following specialisation papers, eachconsisting of two papers.

Paper IV, & V :

(i) Accounting (or) (ii) Advanced Banking

b) M.A. English :

Paper - IV & V : Twentieth Century Literature

c) M.A. Hindi :

Previous : Paper V :

(i) Premchand (or) (ii) Mohan Rakesh

Final : Paper - IX :

(i) Hindi Katha Sahitya (or) (ii) Folk Literature

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d. M.A. TELUGU :

Previous : Final :

Paper-IV : Optional Paper-I :

i.| s#q (s*+)

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j) M.A./M.Sc. MATHEMATICS : Any THREE out of the following :

1) Number Theory 2) Lattice Theory 3) Commutative Algebra

4) Integral Equations 5) Linear Programming and Game Theory

6) Numerical Analysis and Computer Techniques 7) Universal Algebra

I here by declare that all the information given above is true and I fully understand that my admission standscancelled at any stage if it is discovered that I do not have the minimum prescribed qualification and / or any informationsupplied by me is found to be false and inadequate. Further, I undertake to be a disciplined student and abide by theorders issued from time to time by the authorities of the School and the University.

Place :

Date :

SIGNATURE OF THE APPLICANT

Enclose the following with th is Application in Original :

a. Degree / Provisional Certificate of the Qualifying Examination passed : (One attested copy also to be enclosed along withoriginal certificate).

b. Two copies of recent photographs (Passport Size of the Candidate duly attested by a gazetted officer at the lower portion ofeach photo. One to be affixed to the application and the other to be enclosed).

c. Receipt of Payment of fee (Crossed Demand Draft).

i) University employees / retired university employees have to enclose service certificate from the Registrar, AndhraUniversity, Visakhapatnam if seeking fee concession.

d. Date of Birth Extract.

e. Identity card duly signed and photo affixed.

f. Three address slips duly filled - in.

Note : For candidates who passed the qualifying examinations of other Universities / Boards of Examination:

Candidates seeking admission into various courses who have passed the qualifying examinations of other Universities

are required to pay the following amounts in addition to the First instalment Fee.

i. Recognition Fee ..... ..... ..... Rs. 300/-

i i . Matriculation Fee ..... ..... ..... Rs. 100/-

(For Office use only)

Date of Admission

Verified by

DIRECTOR