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UGC - NATIONAL ELIGIBILITY TEST JUNE, 2011


Print Copy of Application Form
(TO BE SUBMITTED TO THE TEST CENTRE IN DUPLICATE)

To

Roll No. 46200050

Osmania University, Hyderabad-500 0


UNIVERSITY TEST CENTRE

Subject Code 20
Centre Code 46

1. App
2. (i) Post Graduation Exam
2. (ii) Subject of Post-Gra
3. Subject opted f
4. Centre of Exam

1. Name (as per H


Matriculation Ce
6. (i) Date of Birth (as reco
matriculation or equ
cer
7.

Whether relaxation i

8. Ca
9. Visually Handicapped
Physically Handicappe
10. (i) Father's
10. (ii) Mother's
11. Address for Commun

12. Permanent A

Affix recent Passport size


Photograph signed by the
candidate and duly
attested by the Head of
the Deptt./Institution or
Class I Gazetted Officer

(DO NOT USE STAPLER


OR PIN)
Detail of Educational Qualification
13. (a) Examination Appearing/Passed : MA
13. (b) Name of the University : Maulana Azad National Urdu Passed Ph. D.: No
University
13. (c) Year of Passing : 2009
13. (d) Subject Offered : HINDI
13. (e) Specialization ( if any ) : M.PHIL
13. (f) Marks/Grade : Marks
Mark Obtained : 1083
Total Marks : 1700
% of marks obtained : 63.71%

14. Detail of Fee Deposited


Name of the Bank : STATE BANK OF INDIA
Name of the Branch : MANIKONDA (HYD)
Branch Code : 11076
Journal No. : 013279244
Deposit Date : 2011-04-11
Amount : Rs. 110

15. The State/UT which you belong : Karnataka(11)

Place: HYDERABAD Phone No. (with STD Code)


Date: 2011-04-11 Mobile No.: 0949204137
Email: balaji.149@rediffmail.com

Declaration
i) I, BALAJI , hereby declare that all statement made in this application are true, complete and correct to the best of my knowledge and belief and in
the event of any information being found false or incorrect or any ineligibility being detected before or after the test, my candidature is liable to be
cancelled and legal action may be initiated against me.
ii) I fulfill all conditions of eligibility regarding age limit, educational qualification etc. prescribed for the test.
iii) I have gone through the conditions attached to NET and shall abide by the same.
iv) I have deposited the required fee.
v) I have noted that if my application is found incomplete/defective, the same is liable to be rejected summarily and no correspondence will be
entertained in this regard.
vi) I have read and agree with the Notification for the UGC NET including instructions, enclosures, check list and other relevant information.

Signature of Candidate________________

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