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UNIVERSITY BENITO JUAREZ MARG NEW DELHI - 110 021 APPLICATION FORM FOR JUNIOR RESEARCH FELLOWSHIP Subject : (The form must be filled carefully. Incomplete form is liable to be rejected.) 1. Name (in block letters, with surname underlined. State Mr./Ms.): 2. Date of birth: 3. Nationality: 4. Father/husband's name: 5. (a) Present address: Pin CodePh.No. (b) Permanent address: Pin Code.Ph.No.. 6 .If belonging to Scheduled Caste/Tribe, state name of the caste/tribe: 7. Particulars of educational qualifications, starting with matriculation onward . (Please attach attested copies of mark sheets, certificates, diplomas, etc., and give a reference in the last column): Examination Passed and year of passing School/college/university Subjects offered Grade/division Percentage of marks / cumulative grade point Encl. No.

8. Name of the department, college/university where you propose to do research: (a) Department: (b) College/university: (c) Please attach the certificate issued by Head of the department/ Institution certifying that the necessary facilities will be provided for the research work (d) Whether already registered or proposed to register for PhD. Degree, If yes, give details. (e) How long you have worked on approved research project. (f) Name of the supervisor and the post held by him/her. (g) Details of research papers published (if any) with copy of each reprint. Particulars of all research papers may be given on separate sheet. Source of scholarship/fellowship Value & date of commencement/completion Date up to which tenable work has been completed/is in progress

Whether the

9. Present occupation (if employed, indicate the nature of employment and emolum ents drawn per month): 10. Do you suffer from any physical disability? If so, please give details with certification. 11. Mention the place of research Institute & whether the institute is covered u nder UGC Act. If the research is a college, mention the name of University under which the college is affiliated. 12. Any other information relevant to the research work which you may like to gi ve in support of your application.

DECLARATION I,______________________ hereby declare that I have read the rules regarding the award of Junior Research Fellowship of UGC and I engage myself whole time for w ork on the subject under the direction of the supervisor during the tenure of fe llowship . I also declare that to the best of my knowledge and belief the partic ulars given in the form are correct. Place: Date: (Signature of the candidate) (Name in block letters) 14. List of enclosures:

For the use of the university/ college It is certified that necessary facilities will be provided for the research work of .. (Recommendation of the forwarding authority (views of supervisor/ Head of the De pt) regarding candidates suitability for the award should be obtained separately and should be attached with the application.) Place: Date : REGISTRAR/ UNIVERSITY DIRECTOR/ INSTITUTE PRINCIPAL/ COLLEGE (With official seal)