Name of University

    1.

    2.

    3.

    TO BE FILLED BY NOMINEE (THE ONE WHO IS APPLYING FOR THE HONOR)

    The Bio-Data of Nominee


    1. Name:


    2. Home Address:


    City / Dist


    State


    Pin Code


    3. Telephone:

    Res:

    Off:


    4. E-Mail ID:


    5. Present Occupation / Business / Career:


    6. Date of Birth:


    Gender:

    MaleFemale


    7. Educational Qualification (Academic):


    8. Category:

    Please inform YES or NO in the following list.

    a) The Nominee is/was Charged under CRIMINAL LAW

    YESNO

    b) Are you employed in government service now

    YESNO

    c) Are you seeking this honor for political benefit

    YESNO

    d) Do you have any mental disorder

    YESNO

    e) Have you ever been engaged in human trafficking

    YESNO

    f) Have you ever been engaged in illegal money laundering

    YESNO

    g) Have you ever been engaged in abusing transgender

    YESNO

    h) Have you ever been engaged in abusing children

    YESNO

    i) Have you ever been engaged in abusing other colored people

    YESNO

    j) Have you ever been engaged in abusing other caste/community

    YESNO

    k) Are you supporting terrorism by any means

    YESNO

    l) Are you supporting and/or engaged in unlawful prostitution

    YESNO

    m) Have you ever been engaged violating religious freedom

    YESNO

    n) Have you ever been engaged in violating human rights

    YESNO


    I accept the invitation for honorary degree conferred based on nominee's past and present outstanding deeds to the people and nation where he belongs to.


    I understand that honorary degree is purely a decorative and honorable title.


    I Agree to the above declaration

    Nominee's Name & Signature



    Place


    Date


    TO BE FILLED BY NOMINATOR

    Dear Sir/Madam


    I would like to nominate


    Who is having outstanding excellence in


    With regard to this, he/she has made contributions that seem to me quite unparalleled, and he/she made a great difference in the Society / Community / University / State / District / City / Town / Villages.


    I have followed him/her for

    years


    In view of his/her long, successful, and distinguished career, it would be appropriate to confer honorary degree, so I recommend him/her for


    Honorary Degree/Award:

    (types of honorary degrees may be bestowed: the Doctor of Humanity (D.Hum), the Doctor of Letters (Litt.D.), the Doctor of Social Works (D.S.W.))


    In His Service


    Country / Cities / Towns / Taluks / Panchayats / Villages / Societies / Caste / University / Colleges / Schools are benefited


    Approximate population of

    thousands / Lakhs / Crores of people are benefited through his service.

    IMPORTANT NOTE:


    This Nomination form is not ordinary form, it is seeking higher degree in the society, so please carefully fill the nomination form and attach required documents.
    Extra recommendation letters can be attached to add up credentials.

    1. Please fill all the blanks.

    2. At least 2 or more pages of write-up about the Past activities of Nominee must be attached to the application.

    3. Please Attach Supporting materials (photos, cds, copy of record etc.).

    4. Please Attach 2 passport size photos (do not pin the photos, please put it a small pvc cover & pin the cover to the application. Please write the name of nominee behind the photos).

    5. Please Attach National address proof & ID proof.


    IF ALL THE FIELDS ARE NOT FILLED AND THE REQUIRED DOCUMENTS ARE NOT ATTACHED, THE NOMINATION WILL NOT BE ACCEPTED

    1. Nominator's name & Signature





    Place:


    Date:

    2. Nominee's name & Signature





    Place:


    Date:

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