UGC-NET December 2020 and June 2021 cycles

Confirmation Page

Application No. 2105 2000 8981 -

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 USMAN MOHIDEEN K S Date of Birth 14-10-1981
Mother's Name S NOORJAHAN Category General
Father's Name K U SHAHUL HAMEED Gender Male
If you are a PwD Candidate, do you have Yes Type of Disability Locomotor disability as
benchmark disability (40% or more / specified in the Schedule of
“Severe” where percentage is not defined) RPwD Act, 2016
?
Do you need scribe (as the criteria given No- I do not need scribe Nationality Indian
in the Information Bulletin) ?
Do you belong to Minority Community ? Yes Name of Minority Community Muslim
Annual Income of the Parents/Guardian Greater than 4 Lakhs and Less or Equal to 6 Lakhs Are You Diabetic? NO
Subject Name in Post Graduate Exam Psychology

Apply For
Apply For ASSISTANT PROFESSOR Subject Opted for NET Psychology
1st Choice for Exam City TAMIL NADU - CHENNAI 2nd Choice for Exam City TAMIL NADU - KANCHIPURAM
3rd Choice for Exam City TAMIL NADU - VELLORE 4th Choice for Exam City PUDUCHERRY - PUDUCHERRY

Doctorate Details
Whether already a doctoral student? No

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

Contact Details
Address 9/29, S B I COLONY Locality ADAMBAKKAM
City/Town/Village CHENNAI Country India
State /UT TAMIL NADU District CHENNAI
Pin Code 600088 Email Address usm******@gmail.com
Mobile Number 988****353 Land Line No. with --
STD code or any
other Contact No.

Fee Payment Details

Payment Mode: Pay through ICICI Bank Transaction ID: 1534533835
Exam Fee: 250 /- Date of Transaction: 19/08/2021 23:50:26
Fee Submitted On: 19/08/2021
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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