UNIVERSITY INSTITUTE OF TECHNOLOGY UNIVERSITY OF KERALA THIRUVANANTHAPURAM 695 034 APPLICATION FOR ADMISSION TO MSW (EVENING) PROGRAMME . 0Affix a Passport size Photograph & Sign it across Note: Read the prospectus and instructions carefully before filling in. Make all entries in English in your own handwriting using BLOCK LETTERS. Tick appropriate boxes and use codes wherever applicable Study Centre Chosen A. PERSONAL PARTICULARS Code (as per matriculation or equivalent certificate) 1. Name of Applicant (allow space in between names) 2. Age & Date of Birth (in Christian era) 3. Sex Male D Female D 4. Nationality 5. Religion & Community 6. Are you a member of any of the communities eligible for concessions? Yes D No D If Yes, name the community. SC D ST D SEBC D 7. Name of Parent / Guardian 8. Mailing Address 9.Permanent Address PIN PIN Phone: Phone: E. REMITTANCE DETAILS OF REGISTRATION FEE F . D E C L A R A T I O N I,.........................hereby solemnly and sincerely affirm that the statements made and the information furnished in the application form, as also in all enclosures thereto, submitted by me are true. If the information furnished therein is false, I am liable to criminal prosecution and forfeiture of my seat. I hereby agree to abide by the rules and regulations of the institute, if admitted. Place:............... ............ Date: ../../20 . (Signature of the applicant) I, ................ have no objection in my ward ............ joining the course of study and I endorse the statements furnished by him / her. Place:.......... ................ Date: ../../20 . (Signature of the Parent / Guardian) For Office Use Only Admitted to MSW (EVENING) PROGRAMME, as Batch No. .................... for the year(s) ........../........... on ...........(Date of Admission). Admission No. ............ Initial (Office Asst.) .......... Initial (Principal) UNIVERSITY INSTITUTE OF TECHNOLOGY UNIVERSITY OF KERALA ADMIT CARD FOR M.S.W. ENTRANCE TEST Registration No. ..... (To be allotted by the University) Name ...................... Address ....................... ......................... ......................... Signature of the Candidate ........... Name & Designation of the Identifying Officer ........ ........................... ........................... (Note: The name and address should be filled in by the candidate. The photograph and Signature of the candidate should be attested by a gazetted officer by signing across the photograph) To be filled in by the U.I.T. Office Date & Time of the Entrance Test ................. Venue :
