Application FormJoint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 18-12-2011 [Council of Scientific &

Industrial Research]HRD Group, Exam Unit

1. RollNo(To be filled by Office Only) 2. Application No. 11D643316 3. Applied For 4. Subject 5. Exam Centre 6. Meduim of NET Exam(As applicable) 7. Candidate Name 8. Sex 9. Father/Mother/Husband Name 10. Date Of Birth 11. Age As On 01-07-2011 12. Category 13. Physically/Visually Handicape(PH/VH) 14. If VH, Do You Want Scribe's Help : 01 - JRF+LS : 1 - CHE - CHEMICAL SCIENCES : 06 - CHE - CHENNAI : ENGLISH : RAMSANKAR B : MALE : FATHER -> BALAKRISHNAN R : 16-03-1986 : 25 Y, 3 M, 13 D : OBC : NA : NA

15. Degree(M.Sc./Equivalent) 16. If Result Awaited 17. Year Of Appearing in M.Sc. Final Exam (a) Year Of Passing (b) Division (c) Mark Obtained (%) 19. Specialization : (a) Specialization Code (b) Specialization Subject Name 20. If enrolled in MS-PhD program (a) Year of enrollment (b) Year of passing Undergraduate (c) Division/Grade (d) Marks Obtained (%) 21(a) University/Institute Code (b) University/Institute Name

: M.SC. : NO : NA : 2008 : CHEMISTRY : 67 % : 105 : GENERAL CHEMISTRY : NO : NA : NA : NA :0 : 132 : UNIVERSITY OF MADRAS, CHENNAI

18. Give detail of M.Sc./Equivalent Final Exam Result

22. Write your name and complete Mailing Address. Name Address : RAMSANKAR B : 9, 13TH STREETJB ESTATEAVADI

City Pin State

: CHENNAI : 600054 : TAMIL NADU Signature of Candidate ------>

Application No:

11D643316

manent Address : RAMSANKAR B : 155, KEELAPALAYAM STREET TENKASI Pin : 627811 State :TAMIL NADU : ba_ramsankar@yahoo.co.in

IRUNELVELI

ail

DECLARATION ANKAR B, hereby declare that all statements made in this application are true, complete and the best of my knowledge and belief and in the event of any of the information being found false or incorrect eligibility being detected before or after the test my candidature is liable to be cancelled and action initiated e. bmitted only one application for this test. declare that I fulfill all conditions of eligibility regarding Age limits, Educational qualifications etc. prescribed for

lare that I have never been convicted by any court of law. that I have gone through the conditions attached to NET and shall abide by the same. closed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike which is not applicable). and that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be entertained by CSIR in this regard.

Signature of the C

ATTESTATION(For 'RA' Category Only)

icable For You as You have entered RESULT AWAITED as "NO"

the Bank ode n Figure(Rs.) Date

: : : :

INDIAN BANK 588 200 03/09/2011

(To be filled in by Applicant) Branch/City Journal No. Amount in Word(Rs.) Phone

:ANNANAGAR, CHENNAI : J1185518 : TWO HUNDRED : 09940054324

Signature of A se 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 amination Unit) with required certificate(s) by U.P.C. ordinary Post only, as notified in the Employment News/Website by arranging your own envelop (5X11) subscribing your subject code, application n de which should reach to the Sr. Controller of Examination, Examination Unit, Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi-110012 on or before 16.09.2011 11 for remote areas). not staple the hard copy of the Application form & enclosures.