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UGC - NATIONAL ELIGIBILITY TEST JUNE, 2014

Print Copy of Application Form
(ONE COPY TO BE SUBMITTED TO THE COORDINATING INSTITUTION)

To be Filled by the Coordinating Institution only

Roll No.: 06171222 The particulars furnished by the

candidate have been checked and
Ref.No.: 11655184 verified

Bangalore University, Bengaluru – 560 056(06)

__________________________
COORDINATING INSTITUTION
CO-ORDINATOR (Signature)

Subject Code 17
Coordinating Institution Code 06
__________________________
OFFICE SEAL
Affix recent Passport size
1. Applied for : Assistant Professor only Photograph signed by the
candidate and duly
2. Subject opted for NET : Management
attested by the Head of
3. Name : Mr. LOKESH N Deptt. / Institution or
4. Date of Birth (as recorded in matriculation : 12-01-1976 Class-I Gazetted Officer
or equivalent certificate)
5. (i) Sex : MALE (ii) Category : OBC (DO NOT USE STAPLER
6. Visually Challenged / Physically : Not Applicable OR PIN)
Challenged
7. Father's Name : Shri R NARASIMHAIAH
8. Mother's Name : Smt. VENKATARATNAMMA
9. Examination Appearing/Passed : MBA
10. Name of the University/Institution : Karnataka State Open University
11. Marks/Grade : Marks
Mark Obtained : 1349 Total Marks : 2550 Marks in % : 52.9%
12. Detail of Fee Deposited in State Bank of India
05-05- Journal No. : 19123774
Deposit Date :
2014
Fee Status : Paid
13. Candidate Phone No. : 08023231079 Mobile No. : 9980688008
14. Email : loks_looks@yahoo.com

Declaration
i) I, LOKESH N, 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: 03-05-2014 ___________________

Place: BANGALORE Signature of Candidate

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