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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.

12D694917
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) 14. If VH, Do You Want Scribe's Help : 01 - JRF : 3 - LIF - LIFE SCIENCES : 20 - PUN - PUNE : 02-ENGLISH : NUPUR SHANTARAM NAGAVEKAR : FEMALE : FATHER -> SHANTARAM GAJANAN NAGAVEKAR : 04-01-1990 : 22 Y, 5 M, 28 D : GEN : NA : NA

15. Write your name and complete Mailing Address. Name: Address: NUPUR SHANTARAM NAGAVEKAR FLAT NO.-12, PLOT NO.-80,MAHESHWAR C.H.S. LTD.,R.A.K. MARG, WADALA MUMBAI 400031 MAHARASHTRA Signature of Candidate ------>

City: Pin: State:

16. Permanent Address Name Address 17. Email : NUPUR SHANTARAM NAGAVEKAR : B-5, PLOT NO.-36,SHAHAJI GANJ,SHIVAJI PARK, State : MAHARASHTRA : nupurnagavekar@gmail.com City : KOLHAPUR Pin : 416002

18. Qualifying Degree

: M.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 (a) Year Of Passing : NA 22. If enrolled in MS-PhD program (a) Year of enrollment (b) Year of passing bachelor degree (c) Division/Grade : RA : 2013 (b) Division : NA : NO : NA : NA : NA (If Result Awaited) (c) Mark Obtained (%) : 0 %

21. Give detail of Final Exam Result (If not Result Awaited)

. or Institution where the candidate has appeared OR will be appearing in the above notified Qualification/Degree Examiniation as applicable). Date:Place: Signature of the Candidate. Human Resource Development Group CSIR Complex.Sc.I declare that I have gone through the conditions attached to NET and shall abide by the same. Library Avenue ./B. NUPUR SHANTARAM NAGAVEKAR. (strike which is not applicable). hereby declare that all statements made in this application are true.09. ATTESTATION(For 'RA' Category Only) I certify that the information given by the candidate Shri/Smt/Kum NUPUR SHANTARAM NAGAVEKAR has been verified by me with reference to records. Branch/City Journal No./InstituteRubber stamp/seal Name:Designation: NOTE : (Attestation should be signed by the Head of the Dept. Controller of Examination.P. 25.C. 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. New Delhi-110012 on or before 24. Pusa. application no. Educational qualifications etc.PUN | 02-ENGLISH] To. Controller of Examinations Examination Unit.I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped).I also declare that I have never been convicted by any court of law.I have submitted only one application for this test. Specialization : (a) Specialization Code : 309 24(a) University/Institute Code (b) University/Institute Name (b) Specialization Subject Name : FOOD BIOTECHNOLOGY : 999 : INSTITUTE OF CHEMICAL TECHNOLOGY. and centre code which should reach to the Sr.Tech.) Challan Date :MATUNGA B : 1858296 : FOUR HUNDRED : 8976411303 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. Sr. (Strike which is not applicable) Signature of the Head of Dept.10.) Phone : : : : INDIAN BANK 018 400 17/09/2012 Cut and Paste following address on your own envelop(5”X11”) (Application for Joint CSIR-UGC Test for JRF/LS (NET). or having completed 10+2+3 years of (BS-4 year/BE/B. Examination Unit. Library Avenue.opposite Institute of Hotel Management. Human Resource Development Group. Name of the Bank Branch Code Amount in Figure(Rs. as notified in the Employment News/Website by arranging your own envelop (5”X11”) superscribing your subject code.I further declare that I fulfill all conditions of eligibility regarding Age limits. and no correspondence will be entertained by CSIR in this regard. December.Also this is certifiied that the candidate is enrolled for M.Please do not staple the hard copy of the Application form & enclosures. Amount in Word(Rs. MUMBAI DECLARATION I.LIF | 20 ./ordinary Post only. 2012) [3 .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 December 2012.I understand that my application will be rejected summarily if found incomplete/ineligible.(d) Marks Obtained (%) :0 Application No: 12D694917 23. CSIR Complex. prescribed forthe test.2012 (01. Challan Detail.2012 for remote areas).

Pusa. New Delhi-110012 .

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