11/22/2016 PhDOnlineApplicationForm::Bits,Pilani

C lickh eretoP rin tth ispage.

LastdateofReceipt:5.00PMon14thDecember2016 BITS,PILANI
ApplicationforAdmissiontoPhDProgrammesIIndsemester20162017
Programme:Mechanical/PartTime

ApplNo.:930150
FullName : MANIRATHINAMR
Gender : Male Dob:04Dec1985
Father'sname : MRAJAMANI
Mother'sname : UMARAJAMANI Pasteapassportsizephotograph
Nationality : Indian
EmailId : [email protected]
Address : Flat307
PARIMALANIVAS
ROADNO2

NEARHARIPURICOLONY
PARK
ALKAPURIP.O
SAROORNAGAR

City : HYDERABAD500035
State : Telangana
ContactNumber : 8019975157
MobileNumber : 9030004299
ProgrammeAppliedfor:PartTime
CampusPreferencesforPhD
CampusPreferences : Pref1:HYDERABAD Pref2: Pref3:
Haveyoueverbeenonthe : No
rollsofBITSasaregular
student
PresentlyEmployed : Yes
Organization:TATAADVANCEDSYSTEMSLIMITED,HYDERABAD
Designation:ASSISTANTMANAGERAEROSPACEQUALITY
HighestQualifyingExamination:HD
NameoftheDegree : MASTEROFTECHNOLOGY
University/Institution : JAWAHARLALNEHRUTECHNOLOGICALUNIVERSITY,HYDERABAD
Subject/Discipline : AEROSPACEENGINEERING
Aggregate%ofMarks/CGPA : 78.5
YearofPassing : 2014
AcademicRecord
Aggregate%
Degrees/ Yearof
Duration University/Institution of Division Subject/Discipline
Diplomas Passing
marks/CGPA
JAWAHARLALNEHRU
MASTEROF AEROSPACE
2014 2 TECHNOLOGICAL 78.5 First
TECHNOLOGY ENGINEERING
UNIVERSITY,HYDERABAD
JAWAHARLALNEHRU
BACHELOROF AERONAUTICAL
2009 4 TECHNOLOGICAL 77.5 First
TECHNOLOGY ENGINEERING
UNIVERSITY,HYDERABAD
10+2Higher HolyCrossMatriculation MATHS,
Secondary 2003 1 HigherSecondarySchool, 77.5 First PHYSICS,CHEMISTRY,
Course Salem,TamilNadu,India BIOLOGY

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11/22/2016 PhDOnlineApplicationForm::Bits,Pilani

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11/22/2016 PhDOnlineApplicationForm::Bits,Pilani

ApplNo.:PH930150

Haveyouclearedanyofthefollowingexamination:

CSIRNET:No GATE:No GPATE:No AnyOther:

NameoftheDepartment
UnderwhichwishtoPursue Mechanical
PhDinBITS:

AerospaceProductsandPartsDesignusingDFMATechniques,Aerospace
MaterialsandPartsManufacturingandProductionprocesses,Aerospace
StructuralAssemblyProcess,AerospaceProcessQualityImprovement
Broadareawishtopurse throughTotalQualityImprovementprocess
PhD:

PaymentDetails
Payment: Applicationfeepaymentthroughonlinepaymentandtransactionidis:272643508

EmploymentRecord
Period Name&Addressofthe Natureof
Designation
From To Organisation Responsibility

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11/22/2016 PhDOnlineApplicationForm::Bits,Pilani
ApplNo.:930150

Ifemployedtickoneoftheoptions:
Iwouldbesponsoredbythe Iwouldcomeonfull Iwouldterminatetheemploymentif
employee leave selected
AwardslikeMeritScholarships,GoldMedal,NSTS,NTS,etc.thatyouhavereceived:
______________________________________________________________________
IfyouhavedoneanyBITSHigherdegreeoritsequivalent(M.E.,M.Pharm.,M.S.,M.Phil.etc.),givedetails:
(a)NameoftheDegree:______________________________________________

(b)Nameofthe
Institution:__________________________________________________________________

(c)Duration:From___________________To___________________

(d)Parttimeorfulltime?____________________________________

(e)Nameofcoursesandmarks(%)orgradesobtained(Attachsyllabiofallcourses,ifdegreeisnotofBITS).

S.No. CourseName PercentageMarks/Grades PrescribedTextBook

10

IfyouhaveappliedforanyotherdegreeprogrammeofBITS,give

(a)ApplicationNo.:________________________________

(b)Nameofdegree:____________________________________
IfyouhaveeverbeenaPh.D.student,

(a)NameoftheInstitution:_______________________________________________________

(b)Duration:From______________________________To______________________________

(c)Researchtopicand
supervisor:_______________________________________________________________________

(d)Fellowship(agencyand
amount):_______________________________________________________________________

(e)Reasonsfor
discontinuing:_______________________________________________________________________

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11/22/2016 PhDOnlineApplicationForm::Bits,Pilani
ApplNo.:930150

HaveyoueverappearedinaPh.D.qualifyingexaminationatBITS? Yes No

IfYes,
(a)IDNo:_______________________________

(b)DatesofExamination:(dd/mm/yyyy)______________________________

(c)Result: Pass Fail
Attachseparatesheetsgiving(i)detailsofTechnicalpublications/patents(Givetitle,name(s)ofthe
author(s)andjournalinwhichappeared)and(ii)ProfessionalAttainments&Distinctions.
Declarationbyfatherorguardian(oremployerincaseofsponsoredcandidates):Idosolemnlyaffirmthat
Ishallberesponsibleforthedisciplineandconductofmyson/daughter/ward/employeeandpayregularly
allhis/herexpensesduringhis/herstayintheInstitute.

Place:____________________________________Signature:_______________________________

Date:____________________________________Name:_______________________________

Designation:_______________________________

Address(incaseofemployer):____________________________________

DeclarationbytheApplicant:Iherebydeclarethattheinformationgivenandstatementsmadeinthis
applicationandalsoinitsaccompanyingattachmentsandenclosuresaretruetothebestofmy
knowledge.Iagreetotheconditionthatifanyinformationoranystatementisfoundtobewrong,my
admissiontotheInstitutewouldautomaticallybecancelled.

Ifadmitted,Ipromisetoabidebytherulesandregulationsinforceorthosethatmayhereafterbemade
fortheadministrationoftheInstitutionandIshalldonothingwhichwillinterferewithitsorderlyworking
anddiscipline.Inallmattersconcerningmeandtheinstitution,itshostel,PracticeSchoolstations,the
decisionoftheVicechancellorshallbebindingonme.

Place:____________________________________Signature:_______________________________

Date:____________________________________Name:_______________________________

PermanentAddress:____________________________

PSRN(applicabletoBITSfacultyonly):_______________________________

EnclosuresrelevanttoPartI?

(a)Proofofdateofbirth

(b)ChallanCopy/OnlineFeereceipt

(c)PhotocopyMarksheetandcertificateofqualifyingdegree

(d)SyllabusofHigherdegreecourses,ifholdingahigherdegree

(e)Anyother,specify__________________________________________

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