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Online Application Form Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 22-06-2014 [Council of Scientific & Industrial Research - HRD Group, Examination Unit]
1. RollNo(To be fille d by O ffice O nly) 2. Applica tion No.

14J645747
3. Applie d For 4. Subject 5. Ex am Ce ntre 6. Me duim of NET Ex a m (As a pplica ble ) : 01 - JRF : 6 - ENG - ENGINEERING SCIENCES : 17 - LUC - LUCKNOW : 02-ENGLISH

7. Ca ndida te Na m e 8. Sex 9. Fa ther/Mothe r/Husba nd Nam e 10. Da te O f Birth 11. Age As O n 01-01-2014 12. Ca te gory 13. Physically/Visua lly Ha ndicape (P H/VH) 14. If VH, Do You W ant Scribe 's He lp

: DEEPA K SA HU : MA LE : FA THER -> RA VI PRA KA SH SA HU : 08-05-1982 : 31 Y, 7 M, 23 D : OBC : NA : NA

15. W rite your nam e a nd com ple te Ma iling Addre ss. Na m e : Address : DEEPA K SA HU 192/68-C TA GORE TOWN A LLA HA BA D- 211002 (U.P.) A LLA HA BA D 211002 UTTA R PRA DESH Signa ture of Ca ndida te ------>

C ity: P in : State :

16. P erm a ne nt Addre ss Nam e Addre ss 17. Em a il : DEEPA K SA HU : 192/68-C TA GORE TOWN A LLA HA BA D- 211002 (U.P.) City : A LLA HA BA D P in : 211002 : deepak.8ecmt@gmail.com

State : UTTA R PRA DESH

18. Q ua lifying De gre e

: B.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 A waited (RA ) category] 19. If R esult Awaite d 20. Ye a r O f Appe a ring in Fina l Exa m : NO : NA (If Re sult Awa ite d)

21. Give de ta il of Final Ex a m R esult (If not R esult Awaite d) (a ) Ye a r O f P a ssing : 2008 22. If e nrolle d in MS-P hD progra m (a ) Ye a r of enrollm e nt (b) Ye a r of pa ssing ba che lor de gre e (c) Division/Gra de (d) Ma rk s O bta ine d (%) (b) Division : FIRST : NO : NA : NA : NA :0 (c) Ma rk O bta ine d (%) : 60.88 %

Applica tion No: 23. Specializa tion : (a ) Specia liza tion Code : 605 ENGINEERING 24(a) Unive rsity/Institute Code (b) Unive rsity/Institute Na m e

14J645747

(b) Spe cializa tion Subje ct Na m e : ELECTRONICS A ND COMMUNICA TION : 999 : UTTA R PRA DESH TECHNICA L UNIVERSITY , LUCKNOW

DECLA RA TION I, DEEPA K SA HU, he re by decla re that a ll sta te m ents m ade in this a pplica tion a re true , com plete and corre ct to the best of m y k nowledge and be lie f a nd in the e ve nt of a ny of the inform a tion being found false or incorre ct or any ine ligibility be ing detected before or a fte r the te st m y candida ture is lia ble to be ca nce lle d a nd a ction initia te d aga inst m e . I have subm itted only one applica tion for this te st. I further de cla re tha t I fulfill a ll conditions of eligibility re garding Age lim its, Educa tiona l qua lifications e tc. prescribe d for the te st. I a lso de cla re tha t I ha ve neve r be e n convicted by a ny court of la w. I decla re tha t I ha ve gone through the conditions a tta che d to NET and shall a bide by the sam e . I have e nclosed the a tte ste d copie s of ce rtifica te of be ing SC/ST/O BC/P H/VH (P hysica lly or Visua lly handica pped), (strike which is not a pplica ble ). I unde rsta nd that m y applica tion will be re je cte d sum m a rily if found incom plete /ine ligible , a nd no corresponde nce will be ente rtained by C SIR in this rega rd. Da te : Pla ce: Signa ture of the Ca ndida te . A TTESTA TION(For 'RA ' Category Only)

Not Applicable For You a s You ha ve ente re d R ESULT AW AITED as "NO " 25. Cha llan Detail. Na m e of the Ba nk Branch C ode Am ount in Figure(R s.) Cha llan Date

: : : :

INDIA N BA NK 674 200 21/02/2014

Branch/City Journa l No. Am ount in W ord(R s.) Phone

:A LLA HA BA D : 572795 : TWO HUNDRED : 8795272057

Signa ture of Applicant Note :P le a se send hard copy of this O NLINE subm itte d a pplica tion form duly signed with re cent pa ssport size Black & white photogra ph along with a copy of origina l cha llan (fe e de posit re ce ipt) m e a nt for C SIR(Ex a m ina tion Unit) with re quire d certifica te (s) by U.P.C./ordina ry Post only, as notifie d in the Em ploym e nt Ne ws/W e bsite by a rra nging your own e nvelop (5X11) supe rscribing your subject code , a pplica tion no., a nd centre code which should re ach to the Sr. C ontrolle r of Exa m ina tion, Ex a m ination Unit, Hum an Re source Deve lopm e nt Group, C SIR C om ple x , Libra ry Avenue , P usa , Ne w Delhi-110012 on or be fore 08-03-2014 (14-03-2014 for re m ote a re as). Please do not staple the hard copy of the A pplication form & enclosures.

Cut and Paste following address on your own envelop(5X11)

(Application for Joint CSIR-UGC Test for JRF/LS (NET), June, 2014) [6 - ENG | 14J645747 | 17 - LUC | 02-ENGLISH]

To, Sr. Controller of Examinations Examination Unit, Human Resource Development Group CSIR Complex,opposite Institute of Hotel Management, Library Avenue Pusa, New Delhi-110012