Online Application FormJoint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET 23-12-2012 [Council of Scientific

& Industrial Research - HRD Group, Examination Unit]

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

12D661751
3. Applied For 4. Subject 5. Exam Centre 6. Meduim of NET Exam(As applicable) 7. Candidate Name 8. Sex 9. Father/Mother/Husband Name 10. Date Of Birth 11. Age As On 01-07-2012 12. Category 13. Physically/Visually Handicape(PH/VH) : 01 - JRF : 5 - PHY - PHYSICAL SCIENCES : 06 - CHE - CHENNAI : 02-ENGLISH

: SURENDAR K : MALE : FATHER -> KRISHNAN P : 04-06-1984 : 28 Y, 0 M, 28 D : SC : NA

14. If VH, Do You Want Scribe's Help : NA 15. Write your name and complete Mailing Address. Name: SURENDAR K Address: City: Pin: State: VELAMMAL INSTITUTE OF TECHNOLOGYPANCHETTIPONNERI THIRUVALLUR 601204 TAMIL NADU Signature of Candidate ------>

16. Permanent Address Name Address : SURENDAR K City : : 4/186 PONNI NAGARPUNGANURRAMJEE NAGAR (PO) TRICHY Pin : 620009 State : TAMIL NADU : surenkphy@gmail.com 17. Email

18. Qualifying Degree : M.SC. [Candidates enrolled for M.Sc. or having completed 10+2+3 years of qualifying examination as given in column 18, may apply under Result Awaited (RA) category]

19. If Result Awaited 20. Year Of Appearing in Final Exam (a) Year Of Passing : 2004 (%) : 78 % 22. If enrolled in MS-PhD program (a) Year of enrollment (b) Year of passing bachelor degree (c) Division/Grade (d) Marks Obtained (%)

: NO : NA (If Result Awaited) (c) Mark Obtained

21. Give detail of Final Exam Result (If not Result Awaited) (b) Division : FIRST : YES : 2012 : 2001 : FIRST : 64 Application No: 23. Specialization : (a) Specialization Code : 510 DYNAMICS 24(a) University/Institute Code (b) University/Institute Name (b) Specialization Subject Name : NON LINEAR : 028 : BHARATHIDASAN UNIVERSITY, TIRUCHIRAPPALLI 12D661751

DECLARATION I, SURENDAR K, hereby declare that all statements made in this application are true, complete andcorrect to the best of my knowledge and belief and in the event of any of the information being found false or incorrector any ineligibility being detected before or after the test my candidature is liable to be cancelled and action initiatedagainst 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 forthe 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

:DOTE., CHENNAI : 590605 : ONE HUNDRED : 9677473819 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) superscribing 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 24.09.2012 (01.10.2012 for remote areas).Please do not staple the hard copy of the Application form & enclosures. Branch/City Journal No. Amount in Word(Rs.) Phone

: : : :

INDIAN BANK 1636 100 10.09.2012

Cut and Paste following address on your own envelop(5X11)

(Application for Joint CSIR-UGC Test for JRF/LS (NET), December, 2012) [5 - PHY | 06 - CHE | 02-ENGLISH]

To, Sr. Controller of Examinations Examination Unit, Human Resource Development Group CSIR Complex,opposite Institute of Hotel Management, Library Avenue Pusa, New Delhi-110012