9/7/2016

CSIR-UGC JRF/NET Exam

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(16D)

Online Application Form

Joint CSIR-UGC Test for JRF & LS(NET), December, 2016
[Council of Scientific & Industrial Research - HRD Group, Examination Unit]
1. R ollNo(To be fille d by O ffice O nly)

2. Application No.

16D720796
16D720796
3. Applie d For

: 01 - JRF

4. Subje ct

: 3 - LIF - LIFE SCIENCES

5. Ex am C e ntre

: 05 - CHA - CHA NDIGA RH

6. Me duim of NET Ex am (As applicable )

: 02-ENGLISH

7. C andidate Nam e

: MA YA KUMA RI

8. Se x

: FEMA LE

9. Fathe r/Mothe r/Husband Nam e

: FA THER -> RA JEEV KUMA R

10. Date O f Birth

: 15-07-1992

11. Age As O n 01-07-2016

: 23 Y, 11 M, 16 D

12. C ate gory

: GEN

13. Physically/Visually Handicape (PH/VH)

: NA

14. If VH, Do You W ant Scribe 's He lp

: NA

15. W rite your nam e and com ple te Mailing Addre ss.
Nam e :

MA YA KUMA RI

Addre ss:

E-34, UNIVERSITY CA MPUS,

KURUKSHETRA UNIVERSITY
KURUKSHETRA

C ity:

KURUKSHETRA

Pin:

136119

State :

HA RYA NA
Signature of C andidate ------>

16. Pe rm ane nt Addre ss

Nam e

: MA YA KUMA RI

Addre ss

: E-34, UNIVERSITY CA MPUS,

KURUKSHETRA UNIVERSITY
KURUKSHETRA
C ity : KURUKSHETRA

17. Em ail

: shrm.maya@gmail.com

Pin : 136119

State : HA RYA NA

Note:Bachelors degree holders will not be eligible for Lectureship]

18. Q ualifying De gre e

: B.TECH.

[Candidates enrolled for M.Sc. or having completed 10+2+3 years of qualifying examination as given in column
18, may apply under Result A waited (RA ) category]
19. If R e sult Awaite d

: NO

20. Ye ar O f Appe aring in Final Ex am

: NA

(If R e sult Awaite d)

21. Give de tail of Final Ex am R e sult (If not R e sult Awaite d)

(a) Ye ar O f Passing : 2016

(b) Division : FIRST

22. If e nrolle d in MS-PhD program

: NO

(a) Ye ar of e nrollm e nt

: NA

(b) Ye ar of passing bache lor de gre e

: NA

(c) Division/Grade

: NA

(d) Mark s O btaine d (%)

:0

http://59.163.216.82:8080/jrf/online/submit_form.jsp

(c) Mark O btaine d (%) : 72 %

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CSIR-UGC JRF/NET Exam

Application No:

16D720796

23. Spe cialization :

(a) Spe cialization C ode : 303

(b) Spe cialization Subje ct Nam e : BIOTECHNOLOGY

24(a) Unive rsity/Institute C ode

: 127

(b) Unive rsity/Institute Nam e

: KURUKSHETRA UNIVERSITY, KURUKSHETRA

DECLA RA TION
I, MA YA KUMA RI, he re by de clare that all state m e nts m ade in this application are true , com ple te and
corre ct to the be st of m y k nowle dge and be lie f and in the e ve nt of any of the inform ation be ing found false or
incorre ct
or any ine ligibility be ing de te cte d be fore or afte r the te st m y candidature is liable to be cance lle d and action
initiate d
against m e .
I have subm itte d only one application for this te st.
I furthe r de clare that I fulfill all conditions of e ligibility re garding Age lim its, Educational qualifications e tc.
pre scribe d for
the te st.
I also de clare that I have ne ve r be e n convicte d by any court of law.
I de clare that I have gone through the conditions attache d to NET and shall abide by the sam e .
I have e nclose d the atte ste d copie s of ce rtificate of be ing SC /ST/O BC /PH/VH (Physically or Visually handicappe d),
(strik e which is not applicable ).
I unde rstand that m y application will be re je cte d sum m arily if found incom ple te /ine ligible , and no corre sponde nce
will be e nte rtaine d by C SIR in this re gard.
Date :
Place :
Signature of the C andidate .
A TTESTA TION(For 'RA ' Category Only)

Not Applicable For You as You have e nte re d R ESULT AW AITED as "NO "
25. C hallan De tail.
Nam e of the Bank
Branch C ode
Am ount in Figure (R s.)
C hallan Date

: INDIA N BA NK
: 2040
: 1000
: 07.09.2016

Branch/C ity
Journal No.
Am ount in W ord(R s.)
Phone

:KURUKSHETRA
: 3680502
: ONE THOUSA ND
: 8950018628

Signature of Applicant
Note:Ple ase se nd hard copy of this O NLINE subm itte d application form duly signe d with re ce nt passport size Black &
white photograph along with a copy of original challan (fe e de posit re ce ipt) m e ant for C SIR (Ex am ination Unit) with
re quire d ce rtificate (s) by U.P.C ./ordinary Post only, as notifie d in the Em ploym e nt Ne ws/W e bsite by arranging your
own e nve lop (5X11) supe rscribing your subje ct code , application no., and ce ntre code which should re ach to the
De puty Se cre tary (Ex am s), Ex am ination Unit, Hum an R e source De ve lopm e nt Group, C SIR C om ple x , Library
Ave nue , Pusa, Ne w De lhi-110012 on or be fore 16-09-2016 (23-09-2016 for re m ote are as).
Please do not staple the hard copy of the A pplication form & enclosures.
Note: ******* No changes in the application form will be allowed after submission*****

http://59.163.216.82:8080/jrf/online/submit_form.jsp

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9/7/2016

CSIR-UGC JRF/NET Exam

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

(Application for Joint CSIR-UGC Test for JRF & LS(NET), December, 2016)
[3 - LIF | 16D720796 | 05 - CHA | 02-ENGLISH]

To,
Deputy Secretary (Exams)
Examination Unit, Human Resource Development Group
CSIR Complex,opposite Institute of Hotel Management, Library Avenue
Pusa, New Delhi-110012

http://59.163.216.82:8080/jrf/online/submit_form.jsp

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