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UGC - NATIONAL ELIGIBILITY TEST DECEMBER, 2013
Print Copy of Application Form
(ONE COPY TO BE SUBMITTED TO THE COORDINATING INSTITUTION)

To be Filled by the Coordinating Institution only
Roll No.: 60550166
Ref.No.: 10703739
The particulars furnished by the candidate
have been checked and verified

Utkal University, Bhubaneswar 751 004(60)
COORDINATING INSTITUTION


__________________________
CO-ORDINATOR (Signature)
Subject Code 55
Coordinating Institution
Code
60




__________________________
OFFICE SEAL

1. Applied for : JRF and Assistant Professor Both

2. Subject opted for NET : Labr. Welfr / Pers. Mgmt / Indl Rela / Labr & Soc
Welfr / HRM
3. Name : Mr. AMIYA RANJAN SWAIN

4. Date of Birth (as recorded in matriculation
or equivalent certificate)
: 07-05-1991
5. (i) Sex : MALE (ii) Category : GEN

6. Visually Challenged / Physically
Challenged
: Not Applicable
7. Father's Name : Shri RABINDRA KUMAR SWAIN
8. Mother's Name : Smt. MEENA SWAIN
9. Examination Appearing/Passed : Other(PM&IR)
10. Name of the University/Institution : Utkal University
11. Marks/Grade : NA


Affix recent Passport size
Photograph signed by the
candidate and duly
attested by the Head of
Deptt. / Institution or
Class-I Gazetted Officer
(DO NOT USE STAPLER
OR PIN)



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Mark Obtained : NA Total Marks : NA Marks in % : NA
12. Detail of Fee Deposited in State Bank of India

Deposit Date : 04-11-2013
Fee Status : Paid
Journal No. : 9181757
13. Candidate Phone No. : Mobile No. : 9778351801
14. Email : amiyaranjan789@yahoo.com

Declaration
i) I, AMIYA RANJAN SWAIN, hereby declare that all statements made in the online application are true, complete and correct to the best of my
knowledge and belief and in the event of any information being found false or incorrect or any ineligibility being detected before or after the
test, my candidature is liable to be cancelled and legal action may be initiated against me. ii) I fulfill all conditions of eligibility regarding age
limit, educational qualification etc. prescribed for the test. iii) I have gone through the conditions attached to NET and shall abide by the same.
iv) I have deposited the required fee. v) I have noted that if my application is found incomplete/defective, the same is liable to be rejected
summarily and no correspondence will be entertained in this regard. vi) I have read and agreed with the Notification for the UGC NET
including instructions, enclosures, check list and other relevant information.



Date: 01-11-2013
___________________
Place: BHUBANESWAR Signature of Candidate