Date of Registration/Print:05-10-2021/05-10-2021 Reference ...

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Date of Registration/Print: 05-10-2021/05-10-2021 Reference No: 22151280

1. Degree : Ph.D.

2. Name : Mr. Xxx XX

3. Date of Birth : 01.01.1998

4. Gender : Male

5. Marital Status : Married

6. Community : BC

7. E mail : [email protected]

8. Mobile : 4422357366

9. Aadhar No. : 123456678

10. Nationality : Indian

11. Category : Part - TimeRegular Faculty member of Govt. AidedPolytechnics situated within Tamil Nadu

12. Faculty : Technology

13. UG Specialisation : CSE

14. PG Specialisation : M.E.-Biopharmaceutical Technology

Degree Awarded(Mode)

: Yes (Full Time)

15. Exam Subject Code : Industrial Engineering and Quality Engineering andManagement ( PME2010 )

16. Contact Details

Office Address Residential Address

Xxx XXSenior Assistant ProfessorDddccFfCHENNAITAMILNADU545666355555

Xxx XXWw Ww WWDINDIGULTAMILNADU1234561233

17. Supervisor Details:

Supervisor Reference No. : 123456 - xxxxx x

Supervisor Recognised department : 1100100 / College of Engineering Campus, Chennai / AllDepartments and Centres

18. Joint Supervisor Details : Not Applicable

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Date of Registration/Print:05-10-2021/05-10-2021 Reference No. : 22151280

19. Father Name : xxxx

20. Mother Name : yyyy

21. Spouse Name : ggg

22. Physically Challenged : no

23. Academic Background (Starting from the latest degree obtained)

Sl.No.

Qualification

Branch Mode

College & University University

Type

Duration(inYear)

Year ofPassing

% of Marks/CGPA

CertificateNo.

1. M.E. Biopharmaceutical Technology

FT AU State University

2021 67 4rg

2 B.E. aa FT aa State University

2016 45 gg

3 HSC aa FT aa 2015 65 gg1

4 10th aa FT a 2013 56 dr56

23.a Course Eligibility applied for PG Degree (if applicable) : Not Applicable

24. Professional Experience (Starting from the Present Employment)

Sl.No.

Designation College / Organisation From To Regular/Temporary/

Contract

Type TotalYears

1. Ss S 23.01.2022 24.10.2022 Regular Teaching 01.22

2.

3.

4.

5.

Total 1.22

25. Publication Details

Sl.No.

Name of theJournal

Paper Title Author Year ofPublication

Paper URL

1. dd dd d 2014 www.a.com

2.

3.

26. Details of Project : Not Applicable

27. Proposed Research Topic : sss

Major Domain : dd

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Date of Registration/Print:05-10-2021/05-10-2021 Reference No. : 22151280

SUPERVISOR DETAILS

Name / Reference No. Dr. xxxxx x / 123456

Designation Professor

Nature of Appointment Regular

Department Department of Comuputer Science and Engineering

College/Organization Address College of Engineering , Guindy, Chennai , - 600025

Mobile No. 9994173956

Date of Retirement 30.06.2034

Area of Specialization Cloud Computing

AU Recognised researchdepartment/centre/institute of Supervisor

1100100 / College of Engineering Campus, Chennai / All Departmentsand Centres

Details of scholars doing research under his/her guidance as Supervisor/Joint Supervisor

Sl. No. Name of the Scholar Reg. No. Degree Faculty Year/Session Supervisor/ Joint Sup.

ResearchStatus

1. Prabu M 1000 M.S. Ice JAN - 2012 Supervisor SynopsisSubmitted

2. Xxxx R 211111 Ph.D. Science JAN - 2021 Supervisor Course Work

3. Xyz R 2114 Ph.D. Ice JULy - 2021 Supervisor Course Work

4. Mahesh R 21147 Ph.D. Science JAN - 2021 Supervisor Course Work

5. Xyz R 7415896 Ph.D. - Supervisor Course Work

6. Prabu M 1000 M.S. Ice JAN - 2012 JointSupervisor

SynopsisSubmitted

(Research Status – Course work / Registration Confirmed / Synopsis Submitted / Thesis Submitted)Certified that I have listed all the research scholars registered under my guidance as Supervisor / Joint Supervisor.

Signature of Supervisor(Name with Seal)

Signature of HOD/Director of the Centre of the Supervisor(Name with Seal)

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Date of Registration/Print:05-10-2021/05-10-2021 Reference No. : 22151280

b) Joint Supervisor : Not Applicable

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Date of Registration/Print:05-10-2021/05-10-2021 Reference No. : 22151280

1. Online Fee receipt

2. One page write up of Research topic signed by the Candidate, Supervisor andJoint Supervisor ( if any )

3. Self attested photocopy of Community Certificate (except for Forward community)

4. Self attested photocopy of 10th or its equivalents

5. Self attested photocopy of HSC or its equivalents

6. Self attested photocopy of UG consolidated mark sheet

7. Self attested photocopy of UG Degree Certificate

8. Self attested photocopy of PG Consolidated Mark Sheet

9. Self attested photocopy of PG Degree Certificate

10 Self attested photocopy of the last Transfer Certificate

11. Self attested photocopy of the appointment order (if Part-time)

12. Project sanction order to the Principal Investigator (if applicable)

13. Relieving order from the employer (Employed candidates, who want to pursue full-time study)

Declaration

I hereby certify that the particulars given above are true, correct and complete to the best of my knowledge and

belief. I am aware that any wrong information or suppression of information and facts may result in punitive action in

addition to cancellation of Ph.D. programme at any stage.

Place :

Date : (Signature of the Candidate)

Signature of Supervisor(Name with Seal)

Signature of HOD/Director of the Centre of the Supervisor(Name with Seal)

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Date of Registration/Print:05-10-2021/05-10-2021 Reference No. : 22151280

Certificate from Engineering College/Research Organization

Where the Candidate is Employed

Certified that Mr./Ms./Mrs. ______________________ is employed as (Designation)

__________________________ in the (Department / Division) __________________________ of (Engineering

College / Organization) ______________________________________________. The College / Organization has

no objection to forward his / her application for admission to Ph. D. Programme.

FOR FULL-TIME:

The employee will be sanctioned study leave for the minimum duration of the research programme and will be

relieved from duty from _______ to _______ in order to undertake Full-time research work in the University

Departments/recognized Departments of Engineering Colleges. The necessary relieving order will be given during

admission.

(OR)

FOR PART-TIME:

The employee will be permitted to undertake Part-time research in the University Departments/recognized

departments of Engineering Colleges and he/she will be permitted to be present for attending course works,

discussion with the supervisor, conduct experiments and participate in seminars and research related discussion.

Further, the required facilities at our Institute/ organization will also be provided to the employee for doing research.

(Strike out whichever not applicable)

Place :

Date : Signature of the Principal with office seal / Signature of the

Head of the R&D organization with office seal

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Date of Registration/Print:05-10-2021/05-10-2021 Reference No. : 22151280

FEE RECEIPT( Office Copy )

Application for Ph.D. Programme January 2022

Reference Number : 22151280

Name of the Candidate : Xxx XX

Degree : Ph.D.

Faculty : Technology

FEE DETAILS FEE STATUS

Application Fee : 600

GST(18%) : 108

Total : 708

Paid Date :

Mode of Payment :

Transaction Id : 2333

Payment Successful

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