NATIONAL BRAIN RESEARCH CENTRE

Deemed University
An Autonomous Institute of Department of Biotechnology
Ministry of Science and Technology
(Government of India)

Instructions for filling the Application form: The candidate to

(1) Use Black/Blue ball point pen only. paste his / her
(2) Application form should be filled in capital letters.
recent passport
(3) Tick 9 the relevant boxes.
(4) Write NA where not applicable. size self attested
photograph

A) INFORMATION ABOUT COURSE :

Course Applied For : Ph.D. in NEUROSCIENCE [ ]

INTEGRATED Ph.D. in NEUROSCIENCE [ ]

Note : Please select only one course out of the above two courses. If you do not select any course or select both the
courses, your application will be rejected. If you are eligible and want to apply for both the courses you should apply
through separate application forms along with requisite fee.)
Note: (Only for the Ph.D. in Neuroscience Programme) :
Candidates who have qualified for JRF in CSIR/UGC/ICMR/ICCSR/ DBT-JRF or any other equivalent national
examination carrying fellowship are exempted from appearing for the Entrance Test. They should apply with the
proof of qualification. They should super scribe the envelope containing the application “Qualified to JRF in
CSIR/UGC/ICMR/ICCSR/ DBT-JRF & the valid period of activation of fellowship up to 6th August, 2010”. They
may be called for the interview subject to fulfilling the other requirements.

IF YOU BELONG TO THE ABOVE CATEGORY TICK MARK (9) HERE- [ ]

B) PERSONAL INFORMATION:

Candidate’s Name:
First ……………………………………. Middle …………………………… Last …….……………………….
Gender : Male [ ] Female [ ]
Category : GEN [ ] SC [ ] ST [ ]
Whether the candidate is a Person With Disability (PWD) : YES [ ] NO [ ]
(If Yes, A certificate from appropriate authority to that effect is to be enclosed).
Date of Birth : Date: ………, Month: …………….., Year: ………………..
Father’s/Husband’s Name:
First ……………………………………. Middle …………………………… Last …….……………………….

Mother’s Name:
First ……………………………………. Middle …………………………… Last …….……………………….

C) MAILING ADDRESS:
Address : ………….…………………………………………………………………………………………………….
………….…………………………………………………………………………………………………….
………….…………………………………………………………………………………………………….
City : …………………………………… Pin : ……………………….. State : …..……………………………..
Nearest Rly. Station : ...………………………………………………………………………………………………….
Contact details (Mandatory) :
……………………………………...(Landline with STD code) .…………………………...................(Mobile)
Email ID (Mandatory) ………………..........................................................
D) EDUCATIONAL DETAILS:
Highest Education Level: Master [ ] Graduation [ ]
Name of Degree:............................................................................................................
(e.g. for Graduation: – B.Sc./ MBBS/ B.Tech./...etc.)
(e.g. for PG : – M.Sc ./ MD /M.Tech./...etc.)
Main Stream-1 Code* Main Stream-2 Code* (Optional)
(* Please fill up the Codes as given below that best matches your subjects in the qualifying examination. You can give a
maximum of two subject streams)

Biology 01 Statistics 02 Psychology 03

Physics 04 Computer Applications 05 Engineering 06
Chemistry 07 Pharmacy 08 Technology 09
Mathematics 10 Veterinary Science 11 Medicine 12
Biotechnology 13 Or any equivalent then specify:................................................................................ 14

Whether Completed qualifying examination: Yes [ ] No [ ].

If NO then mention the appearing month and year : …………………
Details of Educational qualifications
Standard University/Board Year of Marks Percentage
Passing Scored %
Xth Standard

XIIth Standard

Graduation

Post Graduation

Others

Choice of Examination Centre: (PLEASE mention three Examination Centres in order of preference, in case preference is
not provided, NBRC will allot Centre randomly)
Preferences:

1 ….……………….. 1. ALLAHABAD 2. BANGALORE 3. BHOPAL 4. DELHI

2…….……………….
3. ……..……………. 5. GUWAHATI 6 HYDERABAD 7. KOLKATA 8. PUNE

E) DEMAND DRAFT DETAILS

Demand Draft No. Amount Rs. 750/- for General (offline) [ ]
Rs. 300/- for SC/ST/PH [ ]
Date of Issue Issuing
Bank
Demand Draft for offline applicants ( Rs. 750/- for Gen. Candidates and of Rs. 300/- for SC/ST/PH Candidates)
Demand Draft should be drawn in favour of "Director NBRC & payable at Manesar or Gurgaon".
NOTE: Please write your Name, Address, Course Name and Demand Draft No. on the back side of Demand Draft.
 NOTE TO THE CANDIDATE (GENERAL INSTRUCTIONS) : –

(1) Completed Application Form along with all the testimonials (Age certificate, Caste certificate, Educational
Qualification Certificates etc.) and Demand Draft should be sent to:
The Advertiser (NBRC),
Post Box No. 9248
Krishna Nagar Head Post Office
Delhi – 100 051
To reach latest by 6th April, 2010.
(2) If you have already applied Online, and also apply off line, your details of Online would be treated as final.
No correspondence would be entertained in this regard.
(3) Medium of Question Paper will be English.
(4) Candidates may apply for both the programmes as per the pre-requisite eligibility by sending separate
applications and fees to be paid separately.
(5) Reservation for candidates concerned will be as per Govt. of India/ UGC Guidelines.
(6) Incomplete applications and applications received after last date may not be considered.
(7) Canvassing in any form shall disqualify the candidature of applicants.
NOTE: – Check list for the enclosures:
1. Proof of Date of Birth (High School/Matric). [ ]
2. Educational/Technical Qualification [ ]
3. Caste Certificate. (Only for SC/ST Candidates) [ ]
4. Demand Draft Details. [ ]
5. Certificate to be furnished by person with disability if applicable. [ ]