CSIR-UGC JRF/NET Exam

http://203.199.141.241/jrf/online/submit_form.jsp

(12J)

Online Application Form Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 17-06-2012 [Council of Scientific & Industrial Research - HRD Group, Examination Unit]
1. RollNo(To be filled by Office Only) 2. Application No.

12J615877
3. Applied For 4. Subject 5. Exam Centre 6. Meduim of NET Exam(As applicable) : 02 - LECTURERSHIP : 3 - LIF - LIFE SCIENCES : 18 - NAG - NAGPUR : ENGLISH

7. Candidate Name 8. Sex 9. Father/Mother/Husband Name 10. Date Of Birth 11. Age As On 01-01-2012 12. Category 13. Physically/Visually Handicape(PH/VH) 14. If VH, Do You Want Scribe's Help

: KU. VINIYA VIJAY MARDIKAR : FEMALE : FATHER -> VIJAY KESHAV MARDIKAR : 12-03-1975 : 36 Y, 9 M, 17 D : GEN : NA : NA

15. Write your name and complete Mailing Address. Name: Address: KU. VINIYA VIJAY MARDIKAR C/O S. S. SEWALKAR PLOT NO 62, CHHATRAPATINAGAR WARDHA ROAD NAGPUR 440015 MAHARASHTRA Signature of Candidate ------>

City: Pin: State:

16. Permanent Address Name Address 17. Email : KU. VINIYA VIJAY MARDIKAR : C/O S. S. SEWALKAR PLOT NO 62, CHHATRAPATINAGAR WARDHA ROAD City : NAGPUR Pin : 440015 : sharvariss@yahoo.in

State : MAHARASHTRA

18. Degree(M.Sc./Equivalent) 19. If Result Awaited 20. Year Of Appearing in M.Sc. Final Exam 21. Give detail of M.Sc./Equivalent Final Exam Result (a) Year Of Passing : 1998 22. Specialization : (a) Specialization Code : 304

: M.SC. : NO : NA

(b) Division : I

(c) Mark Obtained (%) : 66.10 %

(b) Specialization Subject Name : BOTANY

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CSIR-UGC JRF/NET Exam

http://203.199.141.241/jrf/online/submit_form.jsp

Application No: 23. If enrolled in MS-PhD program (a) Year of enrollment (b) Year of passing Undergraduate (c) Division/Grade (d) Marks Obtained (%) 24(a) University/Institute Code (b) University/Institute Name : NO : NA : NA : NA :0 : 077

12J615877

: GURU GHASIDAS UNIVERSITY, BILASPUR

DECLARATION I, KU. VINIYA VIJAY MARDIKAR, hereby declare that all statements made in this application are true, complete and correct to the best of my knowledge and belief and in the event of any of the information being found false or incorrect or any ineligibility being detected before or after the test my candidature is liable to be cancelled and action initiated against me. I have submitted only one application for this test. I further declare that I fulfill all conditions of eligibility regarding Age limits, Educational qualifications etc. prescribed for the test. I also declare that I have never been convicted by any court of law. I declare that I have gone through the conditions attached to NET and shall abide by the same. I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike which is not applicable). I understand that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be entertained by CSIR in this regard. Date: Place: Signature of the Candidate. ATTESTATION(For 'RA' Category Only)

Not Applicable For You as You have entered RESULT AWAITED as "NO" 25. Challan Detail. Name of the Bank Branch Code Amount in Figure(Rs.) Challan Date

: : : :

INDIAN BANK 00454 400 01/03/2012

Branch/City Journal No. Amount in Word(Rs.) Phone

:NAGPUR : 3037933 : FOUR HUNDRED : 09975572079

Signature of Applicant Note:Please send hard copy of this ONLINE submitted application form duly signed with recent passport size Black & white photograph along with a copy of original challan (fee deposit receipt) meant for CSIR(Examination Unit) with required certificate(s) by U.P.C. ordinary Post only, as notified in the Employment News/Website by arranging your own envelop (5X11) subscribing your subject code, application no., and centre code which should reach to the Sr. Controller of Examination, Examination Unit, Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi-110012 on or before 26.03.2012 (02.04.2012 for remote areas). Please do not staple the hard copy of the Application form & enclosures.

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