CSIR-UGC JRF/NET Exam http://203.199.141.241/online/submit_form.

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(11J)
Online Application Form
Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 19-06-2011
[Council of Scientific & Industrial Research]
HRD Group, Examination Unit

1. RollNo(To be filled by Office Only) 2. Application No.

11J602095

3. Applied For : 01 - JRF+LS

4. Subject : 3 - LIF - LIFE SCIENCES
5. Exam Centre : 01 - BAN - BANGALORE
6. Meduim of NET Exam(As applicable) : ENGLISH

7. Candidate Name : SEEMA.S

8. Sex : FEMALE
9. Father/Mother/Husband Name : FATHER -> C.R.SUBRAMANYA
10. Date Of Birth : 10-05-1987
11. Age As On 01-01-2011 : 23 Y, 7 M, 21 D
12. Category : GEN
13. Physically/Visually Handicape(PH/VH) : NA
14. If VH, Do You Want Scribe's Help : NA

15. Degree(M.Sc./Equivalent) : M.SC.

16. If Result Awaited : NO
17. Year Of Appearing in M.Sc. Final Exam : NA
18. Give detail of M.Sc./Equivalent Final Exam Result
(a) Year Of Passing : 2009
(b) Division : FIRST
(c) Mark Obtained (%) : 73 %
19. Specialization in M.Sc. :
(a) Specialization Code : 306
(b) Specialization Subject Name : MICROBIOLOGY
20(a) University/Institute Code : 023
(b) University/Institute Name : BANGALORE UNIVERSITY, BANGALORE

21. Write your name and complete Mailing Address.

Name : SEEMA.S
Address : 29, MANIVILAS GARDEN, NEAR BEML
LAYOUT, KAMALANAGAR

City : BANGALORE
Pin : 560079

State : KARNATAKA
Signature of Candidate ------>

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CSIR-UGC JRF/NET Exam http://203.199.141.241/online/submit_form.jsp

Application No: 11J602095

22. Permanent Address

Name : SEEMA.S
: 29, MANIVILAS GARDEN, NEAR BEML
Address
LAYOUT, KAMALANAGAR
City : BANGALORE Pin : 560079 State :KARNATAKA
23. Email : ceema510@gmail.com

DECLARATION
I, SEEMA.S, 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"

(To be filled in by Applicant)

Name of the Bank : INDIAN BANK Branch/City :RAJAJINAGAR
Branch Code : 00064 Journal No. : J000334788
Amount in Figure(Rs.) : 400 Amount in Word(Rs.) : FOUR HUNDRED
Challan Date : 04/03/2011 Phone : 9916266483

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. only, as notified in the Employment News/Website by arranging your own envelop (5”X11”)
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 05.04.2011 (12.04.2011 for remote areas).
Please do not staple the hard copy of the Application form & enclosures.

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