HARCOURT BUTLER TECHNICAL UNIVERSITY, KANPUR

Application Form for Admission to PhD Programs

Session 2019-20

TYPE OF PhD PROGRAMS (Select)
PhD PROGRAMES APPLIED FOR:
Personal Details of Candidate
Name of Candidate




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Father Name :
Mother Name :
Date of Birth
Gender
Category
Sub Category

Note:- Candidate who wish to avail the benifit of EWS quota must not be covered under theexisting scheme of reservation for the Scheduled Castes. Scheduled Tribes and the Socially and Econmically classes.

Educational Qualification
# Name of Exam Subject /Branch Board /University Collage /Institute Year of Passing /Appearing % Marks /CGPA Division
Intermediate (10+2)
Graduation
Post Graduation
Other (specify)
Select (if any) Passed with Subject Year of Passing Mention Score Upload Score Card
CONTACT DETAIL OF CANDIDATE
Corresponding Address
Pincode
Permanent Address
Pincode
Contact No
Email
Adhaar
FEE PAYMENT DETAILS
Reference Number
Fee Amount
Payment Date & Time
Mode Of Payment
Fee Description

Online Registration Fee ( 2500 )

DECLARATION

Important Document
Signature Date Place