CSIR-UGC JRF/NET Exam http://59.163.216.82:8080/jrf/online/submit_form.

jsp

You must check your registration status when it is notified on our website csirhrdg.res.in
(16D)
Online Application Form
Joint CSIR-UGC Test for JRF & LS(NET), December, 2016
[Council of Scientific & Industrial Research - HRD Group, Examination Unit]

1. RollNo(To be filled by Office Only) 2. Application No.

16D760632
16D760632
3. Applied For : 01 - JRF
4. Subject : 5 - PHY - PHYSICAL SCIENCES
5. Exam Centre : 01 - BAN - BANGALORE
6. Meduim of NET Exam(As applicable) : 02-ENGLISH

7. Candidate Name : AMIT MAHADEV SUTAR

8. Sex : MALE
9. Father/Mother/Husband Name : FATHER -> MAHADEV GOPAL SUTAR
10. Date Of Birth : 26-07-1987
11. Age As On 01-07-2016 : 28 Y, 11 M, 5 D
12. Category : OBC
13. Physically/Visually Handicape(PH/VH) : NA
14. If VH, Do You Want Scribe's Help : NA

15. Write your name and complete Mailing Address.

Name: AMIT MAHADEV SUTAR
Address: H.NO.142 KALMESHWAR GALLI
BELGUNDI

City: BELGAUM
Pin: 591108

State: KARNATAKA
Signature of Candidate ------>

16. Permanent Address

Name : AMIT MAHADEV SUTAR
: H.NO.142 KALMESHWAR GALLI
Address BELGUNDI
City : BELGAUM Pin : 591108 State : KARNATAKA
17. Email : amitsutar6438@gmail.com

Note:Bachelor’s degree holders will not be eligible for Lectureship]

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 : NO
20. Year Of Appearing in Final Exam : NA (If Result Awaited)
21. Give detail of Final Exam Result (If not Result Awaited)
(a) Year Of Passing : 2013 (b) Division : FIRST (c) Mark Obtained (%) : 61 %
22. If enrolled in MS-PhD program : NO
(a) Year of enrollment : NA
(b) Year of passing bachelor degree : NA
(c) Division/Grade : NA
(d) Marks Obtained (%) :0

1 of 3 9/8/2016 10:49 PM
CSIR-UGC JRF/NET Exam http://59.163.216.82:8080/jrf/online/submit_form.jsp

Application No: 16D760632

23. Specialization :
(a) Specialization Code : 510 (b) Specialization Subject Name : ENERGY SCIENCE
24(a) University/Institute Code : 206
(b) University/Institute Name : SHIVAJI UNIVERSITY, KOHLAPUR

DECLARATION
I, AMIT MAHADEV SUTAR, hereby declare that all statements made in this application are true, 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 have submitted only one application for this test.
I further declare that I fulfill all conditions of eligibility regarding Age limits, Educational qualifications etc. prescribed for
the test.
I also declare that I have never been convicted by any court of law.
I declare that I have gone through the conditions attached to NET and shall abide by the same.
I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike which is
not applicable).
I understand that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be
entertained by CSIR in this regard.
Date:
Place:

Signature of the Candidate.

ATTESTATION(For 'RA' Category Only)

Not Applicable For You as You have entered RESULT AWAITED as "NO"

25. Challan Detail.

Name of the Bank : INDIAN BANK Branch/City :BELGAUM
Branch Code : 534 Journal No. : 4983895
Amount in Figure(Rs.) : 500 Amount in Word(Rs.) : FIVE HUNDRED
Challan Date : 08/09/2016 Phone : 9482406438

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.P.C./ordinary Post only, as notified in the Employment News/Website by arranging your own envelop (5”X11”) superscribing
your subject code, application no., and centre code which should reach to the Deputy Secretary (Exams), Examination Unit,
Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi-110012 on or before 23-09-2016
(30-09-2016 for remote areas).
Please do not staple the hard copy of the Application form & enclosures.
Note: ******* No changes in the application form will be allowed after submission*****

2 of 3 9/8/2016 10:49 PM
CSIR-UGC JRF/NET Exam http://59.163.216.82:8080/jrf/online/submit_form.jsp

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

(Application for Joint CSIR-UGC Test for JRF & LS(NET), December, 2016)
[5 - PHY | 16D760632 | 01 - BAN | 02-ENGLISH]

To,
Deputy Secretary (Exams)
Examination Unit, Human Resource Development Group
CSIR Complex,opposite Institute of Hotel Management, Library Avenue
Pusa, New Delhi-110012

3 of 3 9/8/2016 10:49 PM