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Online Application Form Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 22-12-2013 [Council of Scientific & Industrial Research - HRD Group, Examination Unit]
1. RollNo(To be filled by Office Only) 2. Application No.

3. Applied For 4. Subject 5. Exam Centre 6. Meduim of NET Exam(As applicable) : 02 - LECTURERSHIP : 5 - PHY - PHYSICAL SCIENCES : 16 - KOL - KOLKATA : 02-ENGLISH

7. Candidate Name 8. Sex 9. Father/Mother/Husband Name 10. Date Of Birth 11. Age As On 01-07-2013 12. Category 13. Physically/Visually Handicape(PH/VH) 14. If VH, Do You Want Scribe's Help

: ARJUN BISWAS : MALE : FATHER -> RANJIT BISWAS : 08-11-1990 : 22 Y, 7 M, 24 D : SC : NA : NA

15. Write your name and complete Mailing Address. Name: Address: ARJUN BISWAS VILL-BORODOBA,POST-FALAKATA DIST-JALPAIGURI,(W.B) JALPAIGURI 735211 WEST BENGAL Signature of Candidate ------>

City: Pin: State:

16. Permanent Address Name Address 17. Email : ARJUN BISWAS : VILL-BORODOBA,POST-FALAKATA DIST-JALPAIGURI,(W.B) City : JALPAIGURI Pin : 735211 :


18. Qualifying Degree

: M.SC.

[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 : 2014 (If Result Awaited)

21. Give detail of Final Exam Result (If not Result Awaited) (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 (d) Marks Obtained (%) (b) Division : NA : NO : NA : NA : NA :0 (c) Mark Obtained (%) : 0 %

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P. 2 of 3 07-Aug-13 1:48 PM . /B. Date: Place: Signature of the Candidate. DECLARATION I../Institute Rubber stamp/seal Name: Designation: NOTE : (Attestation should be signed by the Head of the Dept.) Challan Date : : : : INDIAN BANK 00498 100 3/08/2013 Branch/City Journal No. and centre code which should reach to the Sr. I further declare that I fulfill all conditions of eligibility regarding Age limits. Human Resource Development Group. Please do not staple the hard copy of the Application form & enclosures. I declare that I have gone through the conditions attached to NET and shall abide by the same. Examination Unit.C. I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped). Educational qualifications etc.95. Also this is certifiied that the candidate is enrolled for M. or Institution where the candidate has appeared OR will be appearing in the above notified Qualification/Degree Examiniation as applicable). ATTESTATION(For 'RA' Category Only) I certify that the information given by the candidate Shri/Smt/Kum ARJUN BISWAS has been verified by me with reference to records.CSIR-UGC JRF/NET Exam http://115. Specialization : (a) Specialization Code : 510 24(a) University/Institute Code (b) University/Institute Name (b) Specialization Subject Name : PHYSICS : 090 13D612232 : INDIAN INSTITUTE OF TECHNOLOGY. or having completed 10+2+3 years of (BS-4 year/BE/B. 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 also declare that I have never been convicted by any court of law. 25. ARJUN BISWAS.Tech.106/jrf/online/submit_form. Controller of Examination./ordinary Post only. I understand that my application will be rejected summarily if found incomplete/ineligible. New Delhi-110012 on or before 27-08-2013 (02-09-2013 for remote areas). Amount in Word(Rs. prescribed for the test. (Strike which is not applicable) Signature of the Head of Dept.Sc. I have submitted only one application for this test. Pusa. CSIR Complex. and no correspondence will be entertained by CSIR in this regard.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 2013.jsp Application No: 23. as notified in the Employment News/Website by arranging your own envelop (5”X11”) superscribing your subject code.) Phone :GUWAHATI : 1566746 : ONE HUNDRED : 8011033905 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. hereby declare that all statements made in this application are true. Name of the Bank Branch Code Amount in Figure(Rs.112. application no. GUWAHATI. (strike which is not applicable). Challan Detail. Library Avenue.

PHY | 13D612232 | 16 . Sr. New Delhi-110012 3 of 3 07-Aug-13 1:48 PM .jsp Cut and Paste following address on your own envelop(5”X11”) (Application for Joint CSIR-UGC Test for JRF/LS (NET).106/jrf/online/submit_form. Library Avenue Pusa. Human Resource Development Group CSIR Complex.112. December.KOL | 02-ENGLISH] To.CSIR-UGC JRF/NET Exam http://115. 2013) [5 . Controller of Examinations Examination Unit.opposite Institute of Hotel Management.95.