INTERNATIONAL INSTITUTE FOR POPULATION

SCIENCES
(DEEMED UNIVERSITY)
Govandi Station Road, Deonar. Mumbai - 400 088.
(Telegraphic Address : DEMOGRAPHY, Chembur. Mumbai)

Processing Fee
Amount : ` 400/- (Indian Student)*
D.D. No.: ______________________
Bank : ______________________
Date : ______________________
* Exempted for SC/ST/PH Candidates.
 ) : ___________________ District _______________ State
_________________
Telephone/Fax/E-
mail
A : OBC SC ST PH
Name of (b) Permanent P Sub-Caste:-_______________________________________
Affix a recent
the Address (if P (Please attach Certificate from the Competent
Passport size
course Authority. In case of OBC candidates, valid non-
Photograph here
different from L
applied above) creamy layer certificate issued in the last financial
for I
C year should be attached).
1. Name Telephone/Fax/E- A
in full T : Yes No Not Applicable
mail
(In I
block 6. Date of Birth O If yes, state appropriately
letter
N
s) JRF or LECTURERSHIP ONLY
(a) 7. Place of Birth
F
Fathe
r's/H O
usba 8. Are you a R
nd's member of M
Nam
:_____________________________________________________________________
e OBC/SC/ST/PH?
(b)
Moth : Mr./Ms.____________________________________________________
er's
Nam :_______________________________________________________________________
e
9. Have you :_______________________________________________________________________
qualified in 3. Nationality:_____________________
2. Sex:
UGC-NET
Exam (or) 4. Marital Status:_________________
5.
Other
Competitive :______________________________________________________________________
(a)
Pres Exam _______________________________________________________________________
ent (Please Specify)
:______________________________________________________________________
Add
ress ______________ :______________________________________________________________________
______
_______________________________________________________________________
(to
whi :_______________________________________________________________________
ch
com : _______
mun ___________
icati ________ (In
on words_____________
____
sho Day
uld Month Year
be :_______________________________________________________________
sent )
 10. ACADEMIC RECORD (Give particular of all examination and degree obtained starting with 10th grade
or high school)
11. ACADEMIC RECORD

Exam/Degree Board / Institution Month & Division/Class Subject (s) offered

University Year of with Percentage
Passing of Marks*

* In case of grade, please write equivalent percentage of marks.

11. Employment RECORD (if any): (If currently working, enclose a No-Objection Certificate from your
employer)

Employer Post Held From To (Date) Salary last Reason for leaving the post
(Date) Drawn

12. Have you published any paper? If so, give the list of your publications, with details.

13. Give reasons in brief as to why you seek admission and what you expect to gain by this study?

14. Will you be sponsored or self-financed for the Programme? Yes No

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15. If Yes, Sponsored by organization Self-sponsored

[If sponsored by your organization, the employer should fill-in and certify the last page.]

16. Give names, occupations/positions and addresses of two referees, other than your relatives, who are in a
position to give information about you and your work.

(I) ________________________________ (II) _________________________________________

________________________________ _________________________________________
________________________________ _________________________________________
________________________________ _________________________________________

DECLARATION BY THE APPLICANT

I hereby declare that all statements made in this application are true, complete and correct to the best of my
knowledge and belief.

Place:_______________
__________________________
Date:________________ Signature of the Applicant

IMPORTANT

1. INCOMPLETE FORM WILL BE SUMMARILY REJECTED.

2. These instructions shall be read with the instructions as appeared in the advertisement, if any.
3. Application should be sent by Speed Post/Registered Post to the Assistant Registrar (Academic),
International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai-400088, so as
to reach on or before the closing date.
4. Any change of address should immediately be communicated to the Assistant Registrar (Academic), International
Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai-400088.
5. Applicants should send with their applications attested copies of their degrees or other certificates in support
of their educational qualifications and certificate in support of their declaration of age. The candidates in
employment should enclose a No-Objection Certificate from his/her employer.
6. In case of sponsored applicants where the financial liabilities have to be borne by the sponsoring agency, the
Employer should furnish the official statement of sponsorship and provisions and should fill up the form
given overleaf.
4. Only selected candidates will be informed by the office. No interim correspondence will be entertained.
5. If the applicant is a foreign national, the application should be routed through proper channel.
6. A Demand Draft for ` 400/- drawn in favour of the Director, IIPS, Mumbai, should be attached with filled-in
application form along with the enclosures (Exempted for SC/ST/PH Candidates).

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 FOR USE IN CASE OF SPONSORED CANDIDATES ONLY
(To be filled and certified by the Employer)

In case the candidate is selected for the course/study at the International Institute for Population Sciences,
Mumbai, whether the State or Central Government or any other agency with whom the applicant is
working:

(a) will relieve him / her Yes No

(b) will provide him / her deputation allowance and pay during the period of training ?

Yes No

If yes,
Deputation allowance (per month) ` ……………………….

Pay (including allowances) which the

Applicant will be drawing per month
During the training

(c) will bear the cost of field survey,

Travel cost for study tour, etc. Yes No

Certified that Mr./Ms.

_____________________________________________________________________ holds a post in this
Department/Office/Institution/Organization and that the statements made by him/her in this form are
correct to the best of my knowledge and belief. I recommend his/her admission to the training programme
of the Institute.

Signature :
______________________________

Designation :
______________________________

Department/
Office/
Institution/
Organization :
______________________________
Place : _______________________

Date : _______________________ (Office Stamp)