UGC - NET DECEMBER 2019

Confirmation Page

Application No. 1905 2086 9179 -

DO NOT SEND THIS PAGE TO NATIONAL TESTING AGENCY (NTA).
CANDIDATE IS REQUESTED TO RETAIN THE PRINTOUT OF CONFIRMATION PAGE FOR FUTURE REFERENCE.

Personal Details
Candidate's Name TUSHARIKA SAXENA Date of Birth 02-01-1986
Mother's Name ASHA SAXENA Category General
Father's Name MHASHWER DAYAL SAXENA Gender Female
Are you Single Girl Child in your family NO If you are a PwD Candidate, No
without brother or sister? do you have benchmark
disability (40% or more /
“Severe” where percentage is
not defined) ?
Nationality Indian Do you belong to Minority No
Community ?
Name of Minority Community Are You Diabetic? NO

Apply For
Apply For ASSISTANT PROFESSOR Subject Opted for NET Education
1st Choice for Exam City UTTAR PRADESH - BAREILLY 2nd Choice for Exam City UTTAR PRADESH - MORADABAD
3rd Choice for Exam City UTTAR PRADESH - LUCKNOW 4th Choice for Exam City UTTAR PRADESH - AGRA

Research/M.Phil/PhD/ExServiceman Details
Specialization, if Any
Whether you Poses Research Experience in the subject of PG Degree NO
Whether M.Phill Passed/Appearing NO
Whether Ph.D. Passed/Appearing NO
Whether you are an Ex-Serviceman ? NO

Contact Details
Address 43 KUNWARPUR Locality DR LAXMI NARAYAN MARG
City/Town/Village BAREILLY District BAREILLY
State /UT UTTAR PRADESH Pin Code 243003
Email Address tus****************@gmail.com Mobile Number (+91) 894****898
Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through SBI(MOPS) Transaction ID: CPV3135024
Exam Fee: 1000 /- Date of Transaction: 08/10/2019 12:17:43
Fee Submitted On: 08/10/2019
DECLARATION
I hereby declare that all the particulars given by me in this form are true to the best of my knowledge and belief and any mistake / misinformation, detected at the time
of admission or at any stage in future, will result in the cancellation of admission/candidature. I have read the information bulletin and understood all the procedures. In
case I furnish any false information, my result will not be declared/ my candidature will automatically stand cancelled. I shall abide by terms and conditions therein.

Images Uploaded by Candidate

Photograph Signature

List of Document Uploaded

Photograph,Signature

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