Application form for
MSc in ‘Bioinformatics and Biotechnology’ 2012-2014

(Degree awarded by IGNOU, New Delhi)

Note: This form will not be accepted unless an authentic DD number is entered. Please have the DD in hand before filling the form.

1. Full Name of the applicant:

First/Given name Middle name Last name

2. Date of birth: Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

3. Sex: Male Female

4. Permanent address:

Address City State

Pincode

5.Address for correspondence:

Address City State

Pincode

6.Current phone numbers:

Telephone Mobile 1 Alternate Mobile 2

7. Active E-mail Id's:

E-mail ID 1 Alternate E-mail ID 2

8. Academic details:

Examination Passed	Name of Institution Studied	University/Board affiliation	Main subject of study	Year of passing	Overal % marks/grades obtained
SSLC PUC/HSC Select Degree B.Sc B.E B.Tech BVSc B.Pharm BCA BDS BVMS B.Sc.F B.H.Sc B.E M.B.B.S BUMS BAMS BHMS Others Others				1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

9. Work experience:    Yes No

Name of Organization	Designation	Period of Service

10. Do you need hostel accommodation? Yes No

11. Are you an NRI/foreign Student? (If yes please forward photocopies of proof for NRI/foreign status).     Yes No

12. Name and address of the academic institution last attended:

Name and Address City State

Pincode Telephone

13. Source of information about IBAB MSc course:
The journal Current Science
Newspaper          Please specify
IBAB website          How did you reach our website? After seeing newspaper advertisement After hearing about the institute After surfing for institutes Any other     
IBAB poster
Any other         Please specify

14. Payment details:

DD no.	Name of the bank and branch	DD issued date	DD amount
			Rs. 500/- 1000/-