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Online Application Form Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 22-12-2013 [Council of Scientific & Industrial Research - HRD Group, Examination Unit]
1. RollNo(To be filled by Office Only) 2. Application No.

3. Applied For 4. Subject 5. Exam Centre 6. Meduim of NET Exam(As applicable) : 01 - JRF : 1 - CHE - CHEMICAL SCIENCES : 24 - THI - THIRUVANANATHAPURAM : 02-ENGLISH

7. Candidate Name 8. Sex 9. Father/Mother/Husband Name 10. Date Of Birth 11. Age As On 01-07-2013 12. Category 13. Physically/Visually Handicape(PH/VH) 14. If VH, Do You Want Scribe's Help

: GANESH BABU T : MALE : FATHER -> THEAGARAJAN : 15-09-1988 : 24 Y, 9 M, 17 D : GEN : NA : NA

15. Write your name and complete Mailing Address. Name : Address : GANESH BABU T NO:04, REDDY STREET VILLANCHIYAMBAKKAM, KAMARAJ NAGAR AVADI CHENNAI 600071 TAMIL NADU Signature of Candidate ------>

City : Pin: State:

16. Permanent Address Name Address 17. Email : GANESH BABU T : NO:04, REDDY STREET VILLANCHIYAMBAKKAM, KAMARAJ NAGAR AVADI City : CHENNAI Pin : 600071 State : TAMIL NADU :

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 20. Year Of Appearing in Final Exam : NO : NA (If Result Awaited)

21. Give detail of Final Exam Result (If not Result Awaited) (a) Year Of Passing : 2011 22. If enrolled in MS-PhD program (a) Year of enrollment (b) Year of passing bachelor degree (c) Division/Grade (d) Marks Obtained (%) (b) Division : APPLIED CHEMISTRY : NO : NA : NA : NA :0 (c) Mark Obtained (%) : 84 %

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Application No: 23. Specializ ation : (a) Specialization Code : 105 24(a) University/Institute Code (b) University/Institute Name


(b) Specialization Subject Name : APPLIED CHEMISTRY : 010 : ANNA UNIVERSITY, CHENNAI

DECLARATION I, GANESH BABU T, 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)

Not Applicable For You as You have entered RESULT AWAITED as "NO" 25. Challan Detail. Name of the Bank Branch Code Amount in Figure(Rs.) Challan Date

: : : :

INDIAN BANK 1097 400 17/08/2013

Branch/City Journal No. Amount in Word(Rs.) Phone

:AVADI : MU0011762614 : FOUR HUNDRED : 8157902274

Signature of Applicant Note:Please send hard copy of this ONLINE submitted application form duly signed with recent passport siz e 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 (5X11) superscribing your subject code, application no., and centre code 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 27-08-2013 (02-09-2013 for remote areas). Please do not staple the hard copy of the Application form & enclosures.

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Cut and Paste following address on your own envelop(5X11)

(Application for Joint CSIR-UGC Test for JRF/LS (NET), December, 2013) [1 - CHE | 13D700070 | 24 - THI | 02-ENGLISH]

To, Sr. Controller of Examinations Examination Unit, Human Resource Development Group CSIR Complex,opposite Institute of Hotel Management, Library Avenue Pusa, New Delhi-110012

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