Homi Bhabha National Institute

Homi Bhabha National Institute
Regd. Office: 2 nd Floor, Training School Complex, Anushaktinagar, Mumbai 400 094
Enrolment Form for Admission to Doctor of Philosophy (Ph.D.) / Integrated Ph. D. Programme
(For Students from SINP / IPR / IOP/ HRI / TMC / IMSc / OTHERS)
Year 20…..-- 20…..
Affix recent
self attested
photograph
a. Application No(To be filled by CI):
A
P
Enrolment No(To be allotted by HBNI :
b. Constituent Institution(CI) Name:
I desire to enroll in HBNI as a regular student to the ______________________programme in ____________sciences.
1. Full Name (as per Standard XII)
(It is mandatory to write name in Hindi also)
2. Date of Birth (DD/MM/YY)
3. Father/ Mother’s Full Name
4. Address for Correspondence
5. Permanent Address
6. Telephone & Mobile No.
7. Email-ID
8. Category
(General/ SC/ ST/ Others(specify))
9. Nationality
10. Male/ Female
11. Whether Physically/ Visually Challenged
(Yes/No, if Yes give details)
12. Educational Qualifications (starting with graduation degree) (Attach photocopies of all Mark Sheets and Degree Certificates)
Sr. No. Degree Year % Marks Subjects University
Enrolment Form: Ph.D. (For Students) 1/2

13. Date of Internship Completion+
14. State Registration No. & Date+
15. Brief Description of work experience of past two years+ :
+ For the programmes under Board of Health Sciences.
Certified that I am not enrolled in any other Programme of any University. The above information furnished by me is true
and correct. If any information is found to be incorrect or false, I understand that my admission shall be liable to be
summarily terminated without notice.
Date:……………… Place:……………… Signature of the Student: …………………..
Recommendation by the Designated Authority
Certified that the entries made by the student have been verified from the documents submitted. He/she is eligible for
admission to the programme mentioned below as per the relevant ordinance of HBNI.
The said student is recommended for admission in Programme…………………………………….
Date:…………………
Signature of Designated Authority with stamp**
** 1. Dean-Academic (Relevant Discipline) for Ph.D./ Integrated Ph. D. Programme.
CHECK-LIST OF MANDATORY ENCLOSURES FOR APPLICANT
The fee (as applicable) to be paid in the form of crossed DD drawn in favour of: “Accounts Officer, HBNI”.
DD No. Date Drawn on Bank Branch Amount (Rs.)
Attested Photocopies of all Mark Sheets, Degree Certificates including Training School (if applicable) and Proof of Date of Birth.
Enrolment Form: Ph.D. (For Students) 2/2