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FROM REMOTE AREA:
DATE OF EXAM:
17.05.2011 21.05.2011 17.07.2011
INDIAN COUNCIL FOR MEDICAL RESEARCH DIVISION OF MANPOWER DEVELOPMENT,NEW DELHI ICMR/JRF ENTRANCE EXAMINATION-2011 Roll NO. ____________ ( To be assigned by Office )
1. EXAMINATION CENTRE CODE 01) Chandigarh, 02) Chennai, 03) Delhi 04) Kolkata, 05) Mumbai, 06) Hyderabad 07) Guwahati, 08) Varanasi STREAM CODE CATEGORY General ( ) ii) Scheduled Caste iii) Scheduled Tribe B) LIFE SCIENCES C) SOCIAL SCIENCES CODE 3. i) iv) SUBJECT
Name of the Centre
Other Backward Classes
v) Physically Handicapped
Paste copy of recent coloured passport size photograph attested with rubber stamp/seal by the Gazetted Officer All the photographs must be identical.
Draft No. _______________ Date _____________ Amount __________ Name of Issuing Branch _______________________________ ( Draft (Rs.500/- for General/OBC and Rs.300/- for SC/ST/PH ) should be favour of Director, PGIMER,Chandigarh-12 payable at SBI, Medical Institute Code 01524 ) NAME OF THE CANDIDATE ___________________________________ (Exactly as in XII or X Certificate in Block Letters ) FATHER’s NAME MOTHER’S NAME MARITAL STATUS DATE OF BIRTH:
DAY MONTH YEAR
5. 6. 7. 8. 9.
____________________________________ ____________________________________ MARRIED UNMARRIED OTHERS
AGE AS ON 30.09.2011 Years Month Days
( M / F)
PRESENT POSTAL ADDRESS (Do not repeat name as filled in COLUMN 5 & 6 Please mention complete postal address to avoid delay in dispatching admit cards.) HOUSE No./STREET NO. CITY DISTRICT/ STATE ( with pin code) STD CODE - TELEPHONE NO. EMAIL ADDRESS : __________________________________ :__________________________________ : __________________________________ :___________________________________ : __________________________________
PERMANENT ADDRESS: HOUSE No./STREET NO. CITY DISTRICT/ STATE ( with pin code) STD CODE - TELEPHONE NO. : __________________________________ :__________________________________ : __________________________________ :___________________________________
educational qualifications etc. /INSTITUTE AWARDING THE DEGREE: _______________________________ DECLARATION I…………………………hereby declare that all statements made in this application are true. I have noted that my application will be rejected summarily./M..Sc.09. NAME OF THE UNIVERSITY ./MA Final Marks Sheet latest by 30. has been checked by me and it is certified that the candidate is appearing/has appeared in M./Kumari…………………….Sc/MA. I hereby declare that in case I am unable to send the M. (IV/VI Semester whichever is applicable)./Equivalent) (a) Year of Passing (b) Division (c) % of marks (II) YEAR OF APPEARING/HAS APPEARED /RESULT AWAITED ( IN M.Sc./M. Name and signature of the Head of Institute Place………… Date………… Rubber stamp/seal ./Equivalent) -attach appearing certificate from the Head of the Institution Month Year ( 1 ) Result awaited ( 2 ) Result declared ( mention 1 or 2 ) 15. my candidature will deem to be rejected without further correspondence.-214. (I)GIVE DETAILS OF QUALIFYING DEGREE (M. prescribed for the test. strike whichever is not applicable. Place………… ATTESTATION (By Head of the Institution from where the candidate has appeared OR will be appearing in M./Smt. 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.2011. I also declare that I have not been convicted by any court of law.10/( Signature of the candidate ) Date………….Sc.. and no correspondence will be entertained in this regard. if found incomplete/defective. I have enclosed Demand Draft for fee and the attested copies of certificates of SC/ST/OBC/PH. IMPORTANT:PLEASE ENCLOSE ONE SELF ADDRESSED STAMPED ENVELOPE BEARING STAMPS OF RS. I further declare that I fulfill all conditions of eligibility regarding age limits. In the final exam of the year 2010-2011 but result awaited vide roll number_______________. I certify that the information given by the candidate Sh.A. I have submitted only one application for this test.A.MA Final Examination of 2010-2011).Sc. I declare that I have gone through the conditions attached to JRF examination of ICMR and shall abide by the same.
4. ____ Specimen Signature of the Candidate ______________________ Nothing to be written below this line by the candidate______________ ( To be signed at the time of exam.. Specimen Signature of the Candidate ______________________ Please admit Ms. ________________________________ whose photograph alongwith the specimen signature are affixed thereon to the ICMR-JRF entrance examination-2011 mentioned above. _____________ ( to be assigned by Office ) 1.NEW DELHI ICMR/JRF ENTRANCE EXAMINATION-2011 CANDIDATE’S ATTENDANCE SHEET Roll NO. Stream Code (√ ) B) Life Sciences Examination Centre: ( please mention code) Chandigarh Chennai Delhi Kolkata Mumbai Hyderabad Guwahati Varanasi : : : : : : : : 01 02 03 04 05 06 07 08 C) Social Sciences 4.All the photographs must be identical. 3.CHD-12 . Category (√ ) : Gen SC ST OBC PH Stream Code (√ ) B) Life Sciences Examination Centre: ( please mention code) Chandigarh Chennai Delhi Kolkata Mumbai Hyderabad Guwahati Varanasi : : : : : : : : 01 02 03 04 05 06 07 08 C) Social Sciences Paste copy of recent coloured passport size photograph attested with rubber stamp/seal by the Gazetted Officer. 2. All the photographs must be identical.-3- INDIAN COUNCIL OF MEDICAL RESEARCH. _____________ ( to be assigned by Office ) 1. 2.NEW DELHI ICMR/JRF ENTRANCE EXAMINATION-2011 CANDIDATE’S ADMIT CARD Roll NO. ) __________________ Signature of Candidate _____________________ Signature of Invigilator ________________ Date and Time ================================================================== INDIAN COUNCIL OF MEDICAL RESEARCH. Category ( √) : Gen SC ST OBC PH Paste copy of recent coloured passport size photograph attested with rubber stamp/seal by the Gazetted Officer./Mr. REGISTRAR PGIMER. 3.
500/. ************************************************** to . 7. Change of Centre will not be allowed after 10th June. ) shall not be entertained. must be enclosed with the application form. 3.300/. Medical Institute Code No.00 A.Chandigarh. Please enclose one self addressed stamped envelope bearing stamps of Rs. 2011.for SC/ST/Ph ) in favour of Director.2011 at 10. Pin Code to avoid 2. 6. Please Don't send filled application form to ICMR New Delhi.Chandigarh-160012 mentioning on the envelope Application for ICMR-JRF-2011 Exam.PGIMER.00 Noon at notified centres.M 12. Application form containing three pages must be downloaded and send the complete applications form in all respect to the REGISTRAR.10/Draft ( Rs. The examination will be held on Sunday the 17th July. payable at State Bank of India. Please give complete/legible Postal address alongwith delay in sending the admit cards.for General/OBC and Rs.INSTRUCTIONS FOR FILLING THE DOWNLOADED APPLICATION FORMS 1. 5. Incomplete application ( without draft or without signatures etc.1524.PGIMER. 4.