ANDHRA UNIVERSITY DIRECTORATE OF ADMISSIONS

LIFE FERTILITY
(ADVANCED IVF,TRAINING & RESEARCH CENTRE)

Particulars of Demand Draft(s) enclosed towards registration fee (Rs.500/-)
DD in favor of The Registrar, AU common Entrance Test & Admission Account.

D.D.No.

Date

Bank

For Rs.

Passport Size Photo *

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Name of the Course for which admission is sought: *

Name of the Applicant in full *(IN CAPITAL LETTERS)

Father / Guardian’s Name *

Address for Communication *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Phone *

Alternate Phone0 / 10

Email Address *

Aadhar card *

Gender *

Date Of Birth *

Residential status *

Reservation Category *

Minority Community to which you belong *

Note:

Details of Qualifying Examination (Enclose Xerox copy of Provisional pass certificate).

Name of the Qualifying Exam.

Group

University / Board

Year of Passing

Overall % of Marks CGPA

Particulars of study for a period of academic years ending with the qualifying examination.

Class studied (if you did not study during any year, specify reasons)

Academic Year

Name of the institution

Place

State

Class studied (if you did not study during any year, specify reasons)

Academic Year

Name of the institution

Place

State

Class studied (if you did not study during any year, specify reasons)

Academic Year

Name of the institution

Place

State

DECLARATION:

The particulars furnished above are true and correct to the best of my knowledge and I here by agree for thecancellation of my application / admission if any of the above details are found to be false.

Station:

Date:

Signature of the Applicant *

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