UGC CSIR, 2008

For Office Use only

Student No:
12, Masilamani Street, T. Nagar, Chennai – 600 017. U G C 0 8

ENROLMENT FORM
POSTAL SUPPORT PROGRAMME FOR Affix Passport Size
Photo here
THE JOINT UGC-CSIR NATIONAL ELIGIBILITY TEST (NET)
The Principal, 4.5 × 4.5 cms
BRILLIANT TUTORIALS PVT. LTD.
PLEASE ENSURE THAT THIS IS THE COURSE
YOU WISH TO APPLY AND ENROL FOR.
Enclose two more
signed photographs
Sir,
COMPLETE AND SIGN THIS FORM. with this Form
I have passed the Master’s Degree Examination in ………………… (Enrolment forms
Month/Year
from ……………………………………………with ………………………………… will not be accepted
Name of Institution/University Subject
without three
photographs)
Percentage of marks ……………………%
I have appeared/intend to appear for the Master’s Examination or equivalent
in ……………….. from ……………………………….………
Month/Year Name of Institution/University DO NOT REMOVE THIS LABEL OR WRITE IN THIS SPACE
I am aware that my admission to the UGC will be
provisional and subject to cancellation, if I do not
produce proof of having passed the qualifying
examination with a minimum of 55% marks (50%
marks for SC/ST) when required to do so by the UGC.
Have you or any member of your family previously
enrolled in any BT Course. FOR OFFICE USE ONLY
Yes No
If Yes, please give Enrolment No. ………………………
Name ……………………………………
Course: ………………………..……
Please enrol me as a student of your Postal Course for
the UGC-CSIR National Eligibility Test (NET)
June 2008 December 2008 for
Chemical Sciences Life Sciences
Mathematical Sciences Physical Sciences
I herewith remit, by D.D. drawn in favour of Brilliant Tutorials Pvt. Ltd., payable at Chennai,
the course fee of: Rs.7350/- + Service Tax Rs.908/-. Total: Rs.8258/-.
I am paying cash at your office.
(Please 3 the appropriate boxes)
Fees will not be adjusted or refunded under any circumstances
I have read and shall abide by the rules and regulations for this Course given in the Online / Hardcopy Prospectus.
All matters are subject to the jurisdiction of courts in Chennai only. CHEQUES WILL NOT BE ACCEPTED
Yours faithfully,
D.D.No: …………………………….Date: …………………………
Name of Bank: …………………………...…………………………
Signature of Applicant Date:
M.O/ Receipt No: …………………Date: …………………………

(PLEASE PRINT IN BLOCK LETTERS)

Applicant’s Name (as in school records) :
Date of Birth : Date ………… Month …………… Year ………… Sex: Male Female
Category …………………… (General/SC/ST/Ex.S.)

Name and Address of

Parent/Guardian:

Telephone: STD Code: Number:

Own PP

Fax: E.Mail PIN CODE:

Name and Full Postal Address to which
all Correspondence and study material
should be despatched:

Telephone: STD Code: Number:

Own PP
Fax: E.Mail: PIN CODE:
Our course material is in the English Medium only • Fees once paid will not be refunded or adjusted under any circumstances.
• No instalment facility. • Enrolment will not be accepted without the photograph/s. • PIN CODE, AN ABSOLUTE MUST. •
Your application for admission will not be accepted unless your address is complete with Pin Code.
REMEMBER TO SEND TWO ADDITIONAL SIGNED PHOTOGRAPHS WITH THIS FORM.
Please keep a copy of this application for your records
Father’s Name …………………………………………………… Mother’s Name ……………………………………………………

Qualification: Graduate Post Graduate Qualification: Graduate Post Graduate

Occupation: Service Business Professional Occupation: Housewife Employed

1. Brother’s/Sister’s Name ………………………………………… Class ……………

Area of Interest: Engg.,/Med.,/Comm./Others:…………………………………………………………………………

2. Brother’s/Sister’s Name ………………………………………… Class ……………

Area of Interest: Engg.,/Med.,/Comm./Others:…………………………………………………………………………

3. Brother’s/Sister’s Name ………………………………………… Class ……………

Area of Interest: Engg.,/Med.,/Comm./Others:…………………………………………………………………………

GENERAL INSTRUCTIONS

• Please Ensure That This Is The Course You Wish To Enrol For.
• Complete And Sign The Form Wherever Required.
• Cheques will not be accepted.
• Our Course material is in the English Medium only.
• Fee once paid will not be refunded or adjusted under any circumstances.
• No instalment facility please.
• Enrolment will not be accepted without the photograph/s.
• PIN CODE, an absolute must.
• Your application for admission will not be accepted unless your address is complete with pin code.