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Application Form for UGC RFMS

A. Name in Full (in block letters) Mr/Ms ________________________________________________
Father’s Name: Mr _______________________________________________________________
Mother’s Name: Ms______________________________________________________________
Date of Birth: _________________ Place of Birth: ___________________(Rural/Urban): _______
Nationality: _______________
Marital Status: _____________________
Member of Scheduled Caste/Tribe/Backward Class____________ (If yes, then please attach
certificate from Tehsildar/Magistrate I Class of the area)
B. Addresses:
Permanent Address (in block letters)
Present Address:
Phone/MobileNo. ____________________ Email: _______________________________________
C. Educational Qualifications: (Please attach one set of attested copies alongwith original
application only)



Year of


(attach conversion

won if any


Details of Training

B. Pharm.
M. Pharm.
D. Professional Training:


E. Employment Experience (details in chronological order, starting with first job)
Name & Address
Date of
Designation Nature of
Reasons for Leaving
Employer/Institution Joining Leaving

Details of research experience Nature of research Period From Institute Designation To * Annexure if any. Period of Teaching Experience (in Years) Class Subjects Taught Period From To Postgraduate Classes Degree Class Any Other G. participated and sessions presided over the past five years ______________________________________________________________________________________ J. D. A paragraph of self-evaluation regarding admission to Ph. should not exceed 100 words H. if any: _______________________________________________________________________________________ K. if any. use separate sheet if necessary Books Research papers Review articles I.F. _______________________________________________________________________________________ . Publications (please enclose list specifying whether they are of National or International Level): Description Published In Press Accepted for Publication Reference of citation of work in journals/reviews. Seminars/Conferences/Workshops/etc. Membership of Professional Societies. may be given.

_____________________5. _______________________3. _____________________ O. capability and character but must not be in realtions. kept under detention or bound down/fined.L. S. I have never been prosecuted. Declaration: I solemnly declare that: I. _______________________ 6. accomplishments. _____________________ 7. College or other public or Private Organisation Service. For applicants having done post-graduation research. I have never been dismissed from Govt. Supervisor of each major employment and present or most recent employment must be listed. Referees: These should be professionally competent persons. _____________________ 4. Chandigarh II. List of Enclosures: 1.No. _____________________ 2. or from University. the research supervisors must be listed. convicted by the court of law for any offence. The foregoing information is complete and correct. Name Occupation/Position Address M. I am not aware of any circumstances which may impair my fitness for admission to Panjab University. Place: _______________ Date: _______________ _________________ Signature of Applicant . Atleast two of them be citizens of India. Additional Information: (No annexure need to enclosed) _______________________________________________________________________________________ N. III. I have never been disqualified from University work/appearing in any University examination. well aquainted with some aspects of the applicant’s training. IV.