Working Experience

Address for Correspondence

Employed in

Annual Income

25.

26.

Duration

(Cross (X) any one of the Appropriate Box only)

Govt./Public Sector

Upto 1,00000/- 1 lac to 2 lac

Above 10 lacs5 lac to 10 lac

(Do not give Post Box No. address. Leave a blank box between each unit of address like House No., Street Name, P.O., etc.)

Pvt. Sector Self Employed

Years Months.

(Cross (X) any one of the Appropriate Box only)

2 lac to 5 lac

City District

Pin CodeState

Telephone Number Fax No.(if any) with STD Code Mobile No.

(if any)

I hereby declare that I have read and understood the conditions of eligibility for the programme for which I seek admission. I fulfilthe minimum eligibility criteria and have provided necessary information in this regard. In the event of any information being foundincorrect or misleading, my candidature shall be liable to cancellation by the University at any time and I shall not be entitled torefund of any fee paid by me to the University

I have carefully studied the rules of the University as printed in the Prospectus and I accept them and shall not raise any dispute infuture over the same rules.

For filling this Form please refer to “ Instructions for filling the Application form for Entrance Test (OPENMAT)-FORM-1” in the Student Handbook & Prospectus.

Please send your Application form by Registered/Speed Post to the following Address:

1.

2.

3.

4.

5.

6.

Application form received after the due date will not be accepted.

Please retain photo copy of the filled application form for future reference.

No documents are to be attached with this application form.

Date: (Signature of the Applicant)

(if any) with STD Code

STD Code STD CodeTelephone No. Telephone No.

27. 28.

29. E-mail address/ID

DECLARATION BY APPLICANT

INSTRUCTIONS FOR CANDIDATES

Registrar

Student Evaluation Division

IGNOU, MAIDAN GARHI, NEW DELHI-110068

Last date for receipt of filled in application form for OPENMAT XXXVIII is 15 July,2015 and for OPENMAT-XXXIXis 15 December2015.

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BY REGISTERED POST/SPEED POSTAPPLICATION FORM FOR OPENMAT XXXVIII, XXXIX

ENT�NCE TEST

1. PLEASE SEND APPLICATION FORM IN THIS ENVELOPE ONLY2. DO NOT KEEP MORE THAN ONE APPLICATION FORM IN THE ENVELOPE3. DO NOT FOLD STAPLE OR PIN THIS ENVELOPE

SPECIAL INSTRUCTIONS

Name of Candidate

FROM

TO,REGISTRARSTUDENT EVALUATION DIVISION,IGNOU MAIDAN GARHI,NEW DELHI - 110068

PIN