GS-2009

APPLICATION FOR HALL TICKET

Name Date of Birth Photograph Current Address

Telephone No. Email Address SUBJECT PROGRAMME

STD Code

Number

Mobile No. CENTRE

Ph.D. / Int. Ph.D. / M.Sc. (Biology) / Int. Ph.D. & M.Sc. (Biology)

Students applying for Mathematics may please indicate in the subject column whether they should be considred for one of the following : (1)School of Mathematics, Mumbai (2) Applicable Mathematics Bangalore (3) for both Mumbai and Bangalore. Int. Ph.D. programme in Maths is only at Bangalore.

Whether applying under disability category

Blindness or low vision Hearing Impairment

Yes / No

(If yes, please tick category below)

Locomotor disability or cerebral palsy

State the month and year in which you expect to complete B.Sc./B.Sc. (Engg.)/ M.Sc./ B.E./ B.Tech./ M.E./ M.Tech/Others (specify) Degree University / Institute Whether Completed Educational Details : Degree / Exam Std.X / SSC Std.XII / HSC B.Sc. / B.Sc.(Engg.)/ B.E. / B.Tech. M.Sc.(I) / M.E. (I) / M.Tech. (I) M.Sc. (II) / M.E. (II) / M.Tech. (II) OTHERS Demand Draft Details : No. Any Other Information : Dated Bank Board / University Year of Passing Class Percentage Yes / No Month / Year you expect to complete Branch

Date : _________________

Signature : _____________________