,

Indian Institute of Information Technology, Pune

(An Institute of National Importance by an Act of Parliament)
Survey No. 9/1/3, Ambegaon Budruk, Sinhagad Institute Road, Pune – 411041

Ref no: IIITP/PhD/2024-25/4493 Dated: 23/04/2024

Application form for Admission to Ph. D Programme

General Instructions:
(i) Only candidates satisfying the eligibility conditions as per the information brochure may apply.
(ii) Application form without the prescribed fee will not be accepted.
(iii) This form needs to be filled up accurately. Filled form, along with all the necessary enclosures (check-list) is to be
submitted to the address mentioned in the brochure.
(iv) Use additional sheets, if necessary, for providing information under any of the items.
To be filled by office
File No. ................................................. Date of receipt of application...........................................
To be filled by Candidate
Fee Details
Transaction Id: ........................................................... Passport size Self

Date of fee payment.................................................... attested photograph

Bank from which fee is paid…………………………

1. Programmed applied for: Institute PhD Visvesvaraya PhD Both

2. Department to which applied for: ..................................................................................................
3. Name in full ...................................................................................................................................
(in block letters) first name middle name surname
4. Father’s name .................................................................................................................................
5. Present address (for correspondence, in Block Letters): ...............................................................
…….....................................................................................................................................................
.............................................................................................................................................................

6. Permanent address (in Block Letters): ...........................................................................................

...............................................................................................................................................................
….........................................................................................................................................................
7. Contact details: (a) Landline ......................................... (b) Mobile ………..……………………
(c) Email ...................................................... (d) Skype Id ...........................................................
(e) Aadhar No:……………………………………
Page 1 of 3
 8. (a) Date of birth: ......................................... (b) Sex: (Male / Female) ..........................................
9. (a) Category: ............................................... (b) Physically disabled (Yes/No): ............................
10. Nationality...................................................................
11. Academic record: (attach self-attested photocopies of the certificates)
Name of
Year of Percentage Class/
Degree / Institute/ University Subjects
passing / CGPA Rank
Diploma

10th

12th

Undergraduate

Postgraduate (if
applicable)

Others

12. Whether qualified NTA NET/ GATE/CAT/MAT (Score/Rank):

.........................................................................................................................................................
13. Present occupation, designation and affiliation
........................................................................................................................................................
........................................................................................................................................................
14. Work experience: ...........................................................................................................................
.......................................................................................................................................................
15. Mention the source of support or fellowship, if any ......................................................................
...................................................................................................................................................

16. Details of B.Tech / M.Tech./ M.A./M.B.A /M.Sc./M.C.A/ PG Project/Thesis..............................

........................................................................................................................................................
........................................................................................................................................................
17. Declaration: I do hereby solemnly declare that the information given above is correct to the
best of my knowledge and belief. I am fully aware that I must submit attested copies of my
qualifying degree certificate / final transcript, failing which, my admission will stand cancelled.
I am also aware that providing incorrect information in the application form can result in the
cancellation of my admission at any stage.

Place: .................................... Signature of the Applicant

Date: .................................... Name:

Page 2 of 3
 18. List of enclosures (Check List)
Yes / No
Sr. No. Document Description
/ Not Applicable
1. Filled Hard Copy of Application Form (Duly Signed with photograph)
2. Application Fee (online transaction acknowledgement slip)
3. Sponsorship letter
4. Endorsement Certificate
5. NOC from Present Employer
6. Caste/Category/PWD Certificate
7. Identity proof (Election I-Card/ UID Aadhar Card/ PAN etc.),
8. 10th Certificate
9. 10thMarksheet

10. 10+2 Certificate

11. 10+2 Marksheet
12. UG Degree Certificate
13. UG Degree Final Year Marksheet
14. PG Degree Certificate (if any)
15. PG Degree Final Marksheet (if any)
16. NET/ GATE/CAT/MAT Score card (if any)
17. Teaching Experience (if any)

18. Industry Experience (if any)

19. Research Experience (if any)

20. List of Publication (if any)

Page 3 of 3