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Date of Registration: 16-08-2019 Reference No: 2011366
1. Degree : Ph.D.
2. Name : Mr. Xxxxx X
3. Date of Birth : 10.10.1995
4. Gender : Male
5. Marital Status : Unmarried
6. Community : OC
7. E mail : xxxx@[Link]
8. Mobile : 1234567890
9. Nationality : Indian
10. Category : Full - Time
11. Faculty : Civil Engineering
12. UG/PG Specialisation : Urban Engineering ( PCE1011 )
13. Exam Subject Code : ( PCE1011 )
14. Contact Details
Office Address Residential Address
Xxxxx X Xxxxx X
C62 Mgr Nagar 6th Cross Street Tambaram
- Sanatorium
- Velachery
- CHENNAI
TAMILNADU
600042
0
0
15. Supervisor Details:
Supervisor Reference No. : 123456
Supervisor Recognised department : 1100100 / College of Engineering Campus, Chennai / All
Departments and Centres
16. Joint Supervisor Details : Not Applicable
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Date of Registration: 16-08-2019 Reference No. : 2011366
17. Academic Background (Starting from the latest degree obtained)
Sl. Qualificat Branch Mode College & University Year % of M Certificate
No. ion of Pas arks/C No.
sing GPA
1. M.E. Structural Engineering FT Anna University 2019 70.00 123456
2 B.E. Civil Engineering FT Mku 2017 70.00 146165
3 HSC Maths, Physics FT Tn 2013 65.00 4564
4 10th Maths, Social Science FT Tn 2011 70.00 ffsgf
18. Course Equivalence applied for PG Degree (if applicable) : Not Applicable
19. Professional Experience (Starting from the Present Employment)
Sl. Designation College / Organisation Work Period Regular/ Type of Total
No. Temporary/ Employmen Years
Contract t
1. Software Engineer Anna University 24-10-2015 to Temporary Industry 04.10
till date
2.
3.
4.
5.
Total 4.1
20. Details of current employment : Not Applicable
21. Details of Publications
No. of Journals: :1
No. of Conferences: :
Journal Details: : Computer Algorithm
Conference Details: :
22. Tentative title of the proposed : Algorithm
research topic
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Date of Registration: 16-08-2019 Reference No. : 2011366
SUPERVISOR DETAILS
Name / Reference No. Dr. xxxxx x / 123456
Designation Associate Professor
Nature of Appointment Regular
Department Department of Civil Engineering
College/Organization Address CEG Anna University, Guindy, Chennai , - 600025
Mobile No. 9988888888
Date of Retirement 30.06.2034
Area of Specialization Structural
AU Recognised research 1100100 / College of Engineering Campus, Chennai / All Departments
department/centre/institute of Supervisor and 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 Status
/ Joint Sup.
1. Prabu M 1000 Ph.D. Ice JAN - 2012 Supervisor Course Work
2. Duplicate R 101 M.S. Ice JAN - 2013 Supervisor Course Work
(Research Status – Attending Course works / 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 Signature of HOD/Director of the Centre of the Supervisor
(Name with Seal) (Name with Seal)
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Date of Registration: 16-08-2019 Reference No. : 2011366
b) Joint Supervisor : Not Applicable
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Date of Registration: 16-08-2019 Reference No. : 2011366
1. Online Fee receipt
2. One page write up of Research topic signed by the Candidate, Supervisor and
Joint 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 mark sheets
7. Self attested photocopy of UG Degree Certificate
8. Self attested photocopy of PG mark sheets (Consolidated Mark Sheets)
9. Self attested photocopy of PG Degree Certificate
10 Self attested photocopy of the last Transfer Certificate
11. Self attested photocopy of [Link]. Degree Certificate (if applicable)
12. Self attested photocopies of the appointment orders of the employment listed in item No:19 (if Part-
time)
13. Project sanction order to the Principal Investigator (if applicable)
14. Relieving order from the employer (Employed candidates, who want to pursue full-time study)
15. Proof for Course equivalence application (if applicable)
Mode of UG Degree: Full-time/Part-time (day time)/Part-time (evening)/Distance/Week end
Mode of PG Degree: Full-time/Part-time (day time)/Part-time (evening)/Distance/Week end
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 Signature of HOD/Director of the Centre of the Supervisor
(Name with Seal) (Name with Seal)
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Date of Registration: 16-08-2019 Reference No. : 2011366
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: 16-08-2019 Reference No. : 2011366
FEE RECEIPT
( Office Copy )
Application for Ph.D. Programme January 2020
Reference Number : 2011366
Name of the Candidate : Xxxxx X
Degree : Ph.D.
Faculty : Civil Engineering
FEE DETAILS FEE STATUS
Fee Amount : 5 Payment Successful
Paid Date : 2019-08-16 [Link]
Mode of Payment : Credit Card
Transaction Id : 8920167911
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