Government of India

Ministry of Science and Technology,

Department of Biotechnology DBT-JRF
Personal Information: Program,
Application form for the Biotechnology Eligibility
Test-2011 (BET)
Full Name: CHUTIA SNIGDHA
Coordinated by University of Pune

Please write your name in Devnagri script:

Gender: Female Date of Maritial

Application Form Number: 1117075
Birth: 24/03/1985 Status: Unmarrie
To, d
The Coordinator
Address (DBT-BET)
for Correspondence: C/O-RINA HAZARIKA AZARA HOSPITAL CAMPUS City : GUWAHATI ,
Respected Sir, ,Taluka : AZARA ,Pin : 781017 ,
Dist :KAMRUP
IState
hereby
: ASSAM for appearing at the Biotechnology Eligibility Test (BET)
apply
2011 offered by the Department of Biotechnology, Government of India.
Mobile No.: 9862888246 Telephone No.1: - Telephone No.2:
-
E-mail
E-mail 2:
1: snigdha.cmr@gmail.com
Legal and Social Reservation Information:
Category: Open Physically Handicapped: No
City of Preference for Eligibility Test: Jorhat (Assam):1 Kolkatta:2 New Delhi:3 Chennai:4 Hyderabad:5
Pune:6
Qualifying Examination:
Name of Qualifying Examination: M.Sc (General
Status : Appearing
Biotechnology)
Exam
University: North Eastern Hill University
Seat/Enrolment
(Meghalaya)
No.:
Date of Passed/Appeared/Appearing:
Percentage of Marks/CGPA: Nil
01/07/2011
Graduation Examination:

DD Details:

Required Documents:(while submitting the form, tick [ ] only those check boxes in front of the
document names that u are submitting along with this form.

Sr. Exa Pas Sea Uni Per

No. min sin t ver cen
1 B.Sc
atio Aug
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No. Am Nu RCo Dat ersit
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1 500.
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Sr. No. Document Description Tick Here

Demand Draft of Rs. 500/- for Open Category Candidates and Rs. 250/- for Reserved Category (SC/ST and
1
PH ONLY) Candidates from a nationalized bank in favour of MKCL payable at Pune.

2 Attested true copy of Birth Certificate or any Proof of Date of Birth.

Attested true copy of a bonafied student certificate from HOD/Co-ordinator of the University
3 Department/Institute. (Passing Certificate/Copy of College Leaving Certificate for qualifying exam passed
candidates).

4 Attested true copy of statement of marks of each year/semester of graduation.

Attested true copy of statement of marks of each year/semester of Qualifying Examination (M.Sc. /
5
M.Tech/M.V.Sc Biotechnology etc.)
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Declaration:
I declare that the information furnished by me in the application form is true in all respects and in case any entryor
information is found to be false, this shall entail automatic cancellation of my admission besides rendering me liable to
such action as the University may deem proper. I hereby undertake that I have carefully gone through the eligibility
conditions prescribed in the prospectus for the program. I am applying for and shall appear in the entrance
examination after satisfying myself that I do fulfill the same. If at any stage it is found that I do not fulfill the
minimum prescribed eligibility criteria, my admission, if granted, shall stand cancelled and I shall have no right to
admission whatsoever.
Place: Date: Please sign strictly inside this box in black ink-->
08/03/2011 16:17:12 Name: CHUTIA SNIGDHA
 Important Instructions
1. Admit card for BET will be available only in the login of eligible candidates 10 days before the exam date.
2. Before appearing to the Eligibility Test, you are requested to confirm that 'Maharashtra Knowledge
Corporation Limited' has received your application form and fee, by logging in to the website
http://oasis.mkcl.org/bet with the login ID provided to you, or through our Call Center Facility.
3. You are requested to report at the Eligibility Test venue one hour before the start of the test.
4. Only SC,ST & PH candidates will be paid Second Class (Non AC) railway / Bus fare by the shortest route
from their home town on production of valid tickets.

Procedure for submission of printout of application form

1. Arrange for the required documents enlisted on the printout of the application form.
2. Write your name in Devanagari script in the space provided on the examination form.
3. Write your "Application Form Number", your "Name" , and "Address" behind the Application Fee Demand
Draft.
4. Sign exactly inside the space provided for signature on the printout of the Application form.
5. Enclose the form along with the required documents and Application Fee DD in an A4 size (9" X 12")
envelope.
6. Affix appropriate postage on envelope.
7. Send the envelope to the address mentioned below by post / speed post so as to reach on or before 15 th
March, 2011.

Step 1: Cut address label

Please cut following address label along the dotted line (- - - -)

Application for DBT-JRF Program 2011.

Form No. 1117075

Knowledge-Divine Information Technology Private Limited

I-Space 1st Floor, B- Wing,
1 A, S. No/ 51, Village Bavdhan Khurd,
Near Mahindra First Choice Showroom,
Pune - 411021
Maharashtra,
INDIA
From:
CHUTIA SNIGDHA
C/O-RINA HAZARIKA AZARA HOSPITAL CAMPUS City : GUWAHATI ,
Dist :KAMRUP ,Taluka : AZARA ,Pin : 781017 ,
State : ASSAM

Note : Enclose duly signed printout of application form, Demand Draft and required documents.
Step 2: Paste the cut Step 3: Affix appropriate Step 4: Send it by Post or
address on an A4 size postage on the envelope Courier
envelope
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