Online Application Form Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 19-06-2011 [Council of Scientific & Industrial Research] HRD Group, Examination Unit
1. RollNo(To be filled by Office Only) 2. Application No. 11J602095 3. Applied For 4. Subject 5. Exam Centre 6. Meduim of NET Exam(As applicable) : 01 - JRF+LS : 3 - LIF - LIFE SCIENCES : 01 - BAN - BANGALORE : ENGLISH

7. Candidate Name 8. Sex 9. Father/Mother/Husband Name 10. Date Of Birth 11. Age As On 01-01-2011 12. Category 13. Physically/Visually Handicape(PH/VH) 14. If VH, Do You Want Scribe's Help

: SEEMA.S : FEMALE : FATHER -> C.R.SUBRAMANYA : 10-05-1987 : 23 Y, 7 M, 21 D : GEN : NA : NA

15. Degree(M.Sc./Equivalent) 16. If Result Awaited 17. Year Of Appearing in M.Sc. Final Exam

: M.SC. : NO : NA

18. Give detail of M.Sc./Equivalent Final Exam Result (a) Year Of Passing (b) Division (c) Mark Obtained (%) 19. Specialization in M.Sc. : (a) Specialization Code (b) Specialization Subject Name 20(a) University/Institute Code (b) University/Institute Name : 306 : MICROBIOLOGY : 023 : BANGALORE UNIVERSITY, BANGALORE : 2009 : FIRST : 73 %

21. Write your name and complete Mailing Address. Name Address : SEEMA.S : 29, MANIVILAS GARDEN, NEAR BEML LAYOUT, KAMALANAGAR : BANGALORE : 560079 : KARNATAKA Signature of Candidate ------>

City Pin State

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com DECLARATION I. Educational qualifications etc.. and centre code which should reach to the Sr.) Challan Date : INDIAN BANK : 00064 : 400 : 04/03/2011 Branch/City Journal No.) Phone :RAJAJINAGAR : J000334788 : FOUR HUNDRED : 9916266483 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. New Delhi-110012 on or before 05.CSIR-UGC JRF/NET Exam http://203. ATTESTATION(For 'RA' Category Only) Not Applicable For You as You have entered RESULT AWAITED as "NO" (To be filled in by Applicant) Name of the Bank Branch Code Amount in Figure(Rs.2011 (12. Examination Unit. Library Avenue.199. SEEMA. I understand that my application will be rejected summarily if found incomplete/ineligible. MANIVILAS GARDEN. prescribed for the test. NEAR BEML LAYOUT. 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 enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped). hereby declare that all statements made in this application are true.141. I declare that I have gone through the conditions attached to NET and shall abide by the same.S : 29. Pusa. (strike which is not applicable). I further declare that I fulfill all conditions of eligibility regarding Age limits. 2 of 2 Wednesday 09 March 2011 11:11 AM . only. Please do not staple the hard copy of the Application form & enclosures. as notified in the Employment News/Website by arranging your own envelop (5”X11”) subscribing your subject code. I have submitted only one application for this test. Email : ceema510@gmail. Permanent Address Name Address : SEEMA. I also declare that I have never been convicted by any court of law.C. Date: Place: Signature of the Candidate. and no correspondence will be entertained by CSIR in this regard.04.jsp Application No: 22.S. Amount in Word(Rs. application no.241/online/submit_form.04. CSIR Complex. KAMALANAGAR Pin : 560079 State :KARNATAKA 11J602095 City : BANGALORE 23. Controller of Examination.2011 for remote areas). Human Resource Development Group.