Please tick the program you are applying for:

Affix Photograph

Personal Details:

IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please mention N/A wherever not applicable

1. Name (in Block Letters): ......................................................................................................................................................

2. Date of Birth: Gender M F Others

3. Correspondence Address: ....................................................................................................................................................

...................................................................................................................................................................................................

..................................................................................................... Pin:

Telephone No: Mobile:

4. Permanent Address: .............................................................................................................................................................

....................................................................................................................................................................................................

...................................................................................................... Pin:

Telephone No: Mobile:

5. Email: .....................................................................................................................................................................................

6. Nationality: ............................................................................................................................................................................

7. Occupation: ............................................................................................................................................................................

8. Name of the Company: .........................................................................................................................................................

9. Designation: ...........................................................................................................................................................................

10. Employer’s Address: ...........................................................................................................................................................

.....................................................................................................................................................................................................

11. Telephone (Off.):

Date: / / 2 0ADMISSION FORM - JANUARY 2015

M M D D Y Y

Part-time PhD (Management)

Energy Transportation Infrastructure

Oil & Gas Aviation Infrastructure

Power Port & Shipping Logistics & Supply Chain

oPart-time PhD (Engineering)

Energy Transportation Health, Safety & Environment

Oil & Gas Aerospace Infrastructure

Power Information Technology

oPart-time PhD (Science)

Health, Safety & Environment Computer Science

oPart-time PhD (Legal Studies)

o o o

o o o

o o

o

o o

Student’s SignatureDate: / / 2 0

Declaration

I hereby state that the information given above is true to the best of my knowledge. In case any information is found to be incorrect, my candidature is liable to be cancelled by the University. I shall abide by the rules and regulations of the University of Petroleum and Energy Studies, including dress code, and expected behavioral norms in line with the University’s special charter. I shall ensure timely payment of all applicable dues.

Work Experience

Name of the Organization DesignationYears of Experience

From To

Your interest in joining UPES?

.....................................................................................................................................................................................................

.....................................................................................................................................................................................................

.....................................................................................................................................................................................................

.....................................................................................................................................................................................................

Special Achievements

.....................................................................................................................................................................................................

.....................................................................................................................................................................................................

.....................................................................................................................................................................................................

.....................................................................................................................................................................................................

How did you hear about us?

o Website o Newspaper o Emailer o SMS o Magazine o Any Other .......................................

Educational Qualifications

Stream/Degree % & Grade Board/University

Class X

Class XII

Graduation

Post Graduation

Any Other

Year of Passing

From To

Specimen Signature of the Student

2. Duration of the Program: January 1st 2015 to December 31st 2017

3. SAP ID (For Office use only):

4. Student’s Name (in English Capital Letters): .........................................................................

........................................................................................................................................................

5. Father’s Name: ......................................................................................................................................................................

6. Mother’s Name: .....................................................................................................................................................................

7. Spouse's Name:

8. Correspondence Address: ....................................................................................................................................................

.....................................................................................................................................................................................................

..................................................................................................... Pin:

Telephone No: Mobile:

9. Permanent Address: .............................................................................................................................................................

...................................................................................................................................................................................................

..................................................................................................... Pin:

Telephone No: Mobile:

10. Telephone (Off.):

11. Emergency Contact No.:

12. Blood Group:

....................................................................................................................................................................

Authorized Signatory

IMPORTANT GUIDELINES: All the below mentioned fields are mandatory. Please fill in BLOCK LETTERS.

INFORMATION FORM FOR IDENTITY CARD

Affix Photograph

1. Name of the Program:

Part-time PhD (Management)

Energy Transportation Infrastructure

Oil & Gas Aviation Infrastructure

Power Port & Shipping Logistics & Supply Chain

oPart-time PhD (Engineering)

Energy Transportation Health, Safety & Environment

Oil & Gas Aerospace Infrastructure

Power Information Technology

oPart-time PhD (Science)

Health, Safety & Environment Computer Science

oPart-time PhD (Legal Studies)

o o o

o o o

o o

o

o o

PhD Programs

Please send the filled in Admission Form along with:

1. Non-refundable Admission Form fees of `2,000/- (through demand draft) in favor of “UPES”, payable at Dehradun.

2. Xth & XIIth class certificates and mark sheets (photocopies should be self attested).

3. Graduation certificate & mark sheets (photocopies should be self attested).

4. Post graduation certificates & mark sheets (photocopies should be self attested).

5. Any other degree/diploma/certificates (as mentioned in the application form).

6. 1 copy of Research Proposal

7. Bio-Data

8. 2 passport size photographs affixed on the form.

9. 1 passport size digital photograph and scanned signature.

10. Work experience certificate(s).

11. Completed ID form.

www.upes.ac.in

All these documents should reach us at the earliest at the following address:

INSTRUCTIONS FOR SENDING THE ADMISSION FORM

K.K. Bhatnagar

Associate Director (Marketing)

University of Petroleum & Energy Studies

Marketing & Communication Office

2nd Floor, 210,Okhla Phase III,

Industrial Area,New Delhi -110020

Tel: +91-11-41730151-53

Fax: +91-11-41730154