07/03/2017 CSIR-UGC JRF/NET Exam

(17J)
OnlineApplicationForm
JointCSIRUGCTestforJRF&LS(NET),June,2017
[CouncilofScientific&IndustrialResearchHRDGroup,ExaminationUnit]

1.RollNo(TobefilledbyOfficeOnly) 2.ApplicationNo.

17J750455

3.AppliedFor :01JRF
4.Subject :5PHYPHYSICALSCIENCES
5.ExamCentre :18NAGNAGPUR
6.MeduimofNETExam(Asapplicable) :02ENGLISH

7.CandidateName :SAURABHKUMAR
8.Sex :MALE
9.Father/Mother/HusbandName :FATHER>BABANSINGH
10.DateOfBirth :05081994
11.AgeAsOn01012017 :22Y,4M,27D
[OBCcategorycandidatesnotbelongingtoOBC(NonCreamyLayer)andwhosecasteisnotlistedinCentrallist
shallindicatetheircategoryasGeneral.Seepara2.2andpara5.1ofmainnotification]
12.Category :GEN
[ForS.no.13and14onlyPersonswith40%andabovedisability(PwD)aspervalidmedicalcertificateshallbe
considered]
13.PersonwithDisablity(PwD)? :NA
14.IfPwD,Doyouwantscribe'shelp :NA

15.WriteyournameandcompleteMailingAddress.
Name: SAURABHKUMAR
Address: KUMUDSINGHBHAWAN
OPPOSITEVETERINARYHOSPITAL
SHEETALTOLA
City: ARRAH
Pin: 802301

State: BIHAR

SignatureofCandidate>

16.PermanentAddress
Name :SAURABHKUMAR
:KUMUDSINGHBHAWAN
Address OPPOSITEVETERINARYHOSPITAL
SHEETALTOLACity:ARRAHPin:802301State:BIHAR
17.Email :saursk@gmail.com

Note:BachelorsdegreeholderswillnotbeeligibleforLectureship]
18.QualifyingDegree :B.E.
[CandidatesenrolledforM.Sc.orhavingcompleted10+2+3yearsofqualifyingexaminationasgivenincolumn
18,mayapplyunderResultAwaited(RA)category]
19.IfResultAwaited :NO
20.YearOfAppearinginFinalExam :NA(IfResultAwaited)
21.GivedetailofFinalExamResult(IfnotResultAwaited)
(a)YearOfPassing:2016(b)Division:FIRSTCLASS(c)MarkObtained(%):74.16%
22.IfenrolledinMSPhDprogram :NO
(a)Yearofenrollment :NA
(b)Yearofpassingbachelordegree :NA
(c)Division/Grade :NA
(d)MarksObtained(%) :0

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07/03/2017 CSIR-UGC JRF/NET Exam

ApplicationNo: 17J750455

23.Specialization:
(a)SpecializationCode:510(b)SpecializationSubjectName:MECHANICAL
24(a)University/InstituteCode :240
(b)University/InstituteName :VISVESWARAIAHTECHNOLOGICALUNIVERSITY,BELGAUM

DECLARATION
I,SAURABHKUMAR,herebydeclarethatallstatementsmadeinthisapplicationaretrue,completeand
correcttothebestofmyknowledgeandbeliefandintheeventofanyoftheinformationbeingfoundfalseorincorrect
oranyineligibilitybeingdetectedbeforeorafterthetestmycandidatureisliabletobecancelledandactioninitiated
againstme.
Ihavesubmittedonlyoneapplicationforthistest.
IfurtherdeclarethatIfulfillallconditionsofeligibilityregardingAgelimits,Educationalqualificationsetc.prescribedfor
thetest.
IalsodeclarethatIhaveneverbeenconvictedbyanycourtoflaw.
IdeclarethatIhavegonethroughtheconditionsattachedtoNETandshallabidebythesame.
IhaveenclosedtheattestedcopiesofcertificateofbeingSC/ST/OBC/PH/VH(PhysicallyorVisuallyhandicapped),(strikewhich
isnotapplicable).
I understand that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be
entertainedbyCSIRinthisregard.
Date:
Place:

SignatureoftheCandidate.

ATTESTATION(For'RA'CategoryOnly)

NotApplicableForYouasYouhaveenteredRESULTAWAITEDas"NO"

25.ChallanDetail.
NameoftheBank :INDIANBANK Branch/City :NAGPUR
BranchCode :0454 JournalNo. :5788146
AmountinFigure(Rs.) :1000 AmountinWord(Rs.) :ONETHOUSAND
ChallanDate :07/03/2017 Phone :7760936628

SignatureofApplicant
Note:Pleasesend 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.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 Deputy Secretary
(Exams),ExaminationUnit,HumanResourceDevelopmentGroup,CSIRComplex,LibraryAvenue,Pusa,NewDelhi110012on
orbefore14032017(21032017forremoteareas).
PleasedonotstaplethehardcopyoftheApplicationform&enclosures.
Note:*******Nochangesintheapplicationformwillbeallowedaftersubmission*****

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07/03/2017 CSIR-UGC JRF/NET Exam

CutandPastefollowingaddressonyourownenvelop(5X11)

(ApplicationforJointCSIRUGCTestforJRF&LS(NET),June,2017)
[5PHY|17J750455|18NAG|02ENGLISH]

To,
DeputySecretary(Exams)
ExaminationUnit,HumanResourceDevelopmentGroup
CSIRComplex,oppositeInstituteofHotelManagement,LibraryAvenue
Pusa,NewDelhi110012

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