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Academic Record *

No.	Examination	University/Board	Year of Passing	Percentage of Marks obtained	Division/Grade
1
2
3
4
5
6
7
8
9
10

Present Occupation*

If employed,Name Of the office (Supporting Documents to be enclosed)

department in which Ph.D. Provisonal Admission/Registration is sought

Broad Areas of Research interest

Are you getting any Fellowship (If Yes,Details in a separate sheet to be enclosed)

Number of publications,If any