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(16D)
Online Application Form
Joint CSIRUGC 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.
16D708620
16D708620
3. Applied For : 01 JRF
4. Subject : 3 LIF LIFE SCIENCES
5. Exam Centre : 08 DEL DELHI
6. Meduim of NET Exam(As applicable) : 02ENGLISH
7. Candidate Name : DIKSHA GAHLOT
8. Sex : FEMALE
9. Father/Mother/Husband Name : FATHER > VIRENDER SINGH GAHLOT
10. Date Of Birth : 02031995
11. Age As On 01072016 : 21 Y, 3 M, 27 D
12. Category : GEN
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: DIKSHA GAHLOT
Address: H.NO75,VILLAGE TIGIPUR
KARAM SINGH GALI,
POBAKHTAWARPUR
City: DELHI
Pin: 110036
State: DELHI
Signature of Candidate >
16. Permanent Address
Name : DIKSHA GAHLOT
: H.NO75,VILLAGE TIGIPUR
Address KARAM SINGH GALI,
POBAKHTAWARPUR City : DELHI Pin : 110036 State : DELHI
17. Email : gahlotdiksha3@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 : RA
20. Year Of Appearing in Final Exam : 2017 (If Result Awaited)
21. Give detail of Final Exam Result (If not Result Awaited)
(a) Year Of Passing : NA (b) Division : NA (c) Mark Obtained (%) : 0 %
22. If enrolled in MSPhD program : NO
(a) Year of enrollment : NA
(b) Year of passing bachelor degree : NA
(c) Division/Grade : NA
(d) Marks Obtained (%) : 0
Application No: 16D708620
23. Specialization :
(a) Specialization Code : 309 (b) Specialization Subject Name : PLANT MOLECULAR BIOLOGY AND
BIOTECHNOLOGY
24(a) University/Institute Code : 053
(b) University/Institute Name : UNIVERSITY OF DELHI, DELHI
DECLARATION
I, DIKSHA GAHLOT, 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)
I certify that the information given by the candidate Shri/Smt/Kum DIKSHA GAHLOT has been verified by me with reference
to records.
Also this is certifiied that the candidate is enrolled for M.Sc. or having completed 10+2+3 years of (BS4
year/BE/B.Tech./B.Pharma/MBBS/Integrated BSMS or equivalent degree & is eligible to appear under 'RA" category as laid
down in the eligibility criteria of adb[0].getAdv_title(). (Strike which is not applicable)
Signature of the Dean/Head of Dept./Institute
Rubber stamp/seal
Name:
Designation:
NOTE : (Attestation should be signed by the Head of the Dept. or Institution where the candidate has appeared OR will be
appearing in the above notified Qualification/Degree Examiniation as applicable).
25. Challan Detail.
Name of the Bank : INDIAN BANK Branch/City :SHANTI NIKETAN
Branch Code : 329 Journal No. : 3572048
Amount in Figure(Rs.) : 1000 Amount in Word(Rs.) : ONE THOUSAND
Challan Date : 30/08/2016 Phone : 8447194797
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 Delhi110012 on
or before 16092016 (23092016 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*****
Cut and Paste following address on your own envelop(5”X11”)
(Application for Joint CSIRUGC Test for JRF & LS(NET), December, 2016)
[3 LIF | 16D708620 | 08 DEL | 02ENGLISH]
To,
Deputy Secretary (Exams)
Examination Unit, Human Resource Development Group
CSIR Complex,opposite Institute of Hotel Management, Library Avenue
Pusa, New Delhi110012