(15J)

Online Application Form

Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 21-06-2015
[Council of Scientific & Industrial Research - HRD Group, Examination Unit]

1. RollNo(To be filled by Office Only)

2. Application No.

15J697437
3. Applied For

: 01 - JRF

4. Subject

: 3 - LIF - LIFE SCIENCES

5. Exam Centre

: 01 - BAN - BANGALORE

6. Meduim of NET Exam(As applicable)

: 02-ENGLISH

7. Candidate Name

: RAJESHWARI. P

8. Sex

: FEMALE

9. Father/Mother/Husband Name

: FATHER -> PERIYASWAMY. B

10. Date Of Birth

: 06-01-1994

11. Age As On 01-01-2015

: 20 Y, 11 M, 26 D

12. Category

: GEN

13. Physically/Visually Handicape(PH/VH)

: NA

14. If VH, Do You Want Scribe's Help

: NA

15. Write your name and complete Mailing

Address. Name:

RAJESHWARI. P

Address:

NO: 39/28, FIRST LANE

DR. NATESAN ROAD
TRIPLICANE

City:

CHENNAI

Pin:
State:

600005
TAMIL NADU

Signature of Candidate ------>

16. Permanent Address

Name

: RAJESHWARI. P

Address

: NO: 39/28, FIRST LANE

DR. NATESAN ROAD
TRIPLICANE
City : CHENNAI

17. Email

: rajeshwariperiyaswamy@gmail.com

Pin : 600005

State : TAMIL NADU

Note:Bachelors degree holders will not be eligible for Lectureship]

18. Qualifying Degree

: B.TECH.

[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

: RA
: 2015

(If Result Awaited)

21. Give detail of Final Exam Result (If not Result Awaited)
(a) Year Of Passing : NA

(b) Division : NA

22. If enrolled in MS-PhD program

: NO

(a) Year of enrollment

: NA

(b) Year of passing bachelor degree

: NA

(c) Division/Grade

: NA

(d) Marks Obtained (%)

:0

(c) Mark Obtained (%) : 0 %

Application No:

15J697437

23. Specialization:
(a) Specialization Code : 303

(b) Specialization Subject Name : BIOTECHNOLOGY

24(a) University/Institute Code

: 010

(b) University/Institute Name

: ANNA UNIVERSITY, CHENNAI

DECLARATION
I, RAJESHWARI. P, 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)
I certify that the information given by the candidate Shri/Smt/Kum RAJESHWARI. P has been verified by me with reference
to records.
Also this is certifiied that the candidate is enrolled for M.Sc. or having completed 10+2+3 years of (BS-4 year/BE/B.Tech.
/B.Pharma/MBBS/Integrated BS-MS or equivalent degree & is eligible to appear under 'RA" category as laid down in the
eligibility criteria of CSIR-UGC NET June 2015. (Strike which is not applicable)

Signature of the Head of Dept./Institute

Rubber stamp/seal
Name:
Designation:
NOTE : (Attestation should be signed by the Head of the Dept. or Institution where the candidate has appeared OR will
be appearing in the above notified Qualification/Degree Examiniation as applicable).
25. Challan Detail.
Name of the Bank
Branch Code
Amount in Figure(Rs.)
Challan Date

:
:
:
:

INDIAN BANK
00S124
1000
02/03/2015

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

:SIVAKASI
: 1987488
: ONE THOUSAND
: 9003136563

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 Delhi110012 on or before 17-03-2015 (23-03-2015 for remote areas).
Please do not staple the hard copy of the Application form &
enclosures.
Note: ******* No changes in the application form will be allowed after
submission*****

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

(Application for Joint CSIR-UGC Test for JRF/LS (NET), June,

2015) [3 - LIF | 15J697437 | 01 - BAN | 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