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UGC - NATIONAL ELIGIBILITY TEST DECEMBER, 2013 Print Copy of Application Form
(ONE COPY TO BE SUBMITTED TO THE COORDINATING INSTITUTION)

To be Filled by the Coordinating Institution only

Roll No.: 36080308 Ref.No.: 10121051

The particulars furnished by the candidate have been checked and verified

University of Madras, Chennai 600 005(36) COORDINATING INSTITUTION

__________________________ CO-ORDINATOR (Signature)

Subject Code Coordinating Institution Code

08 36 __________________________ OFFICE SEAL : : : : Assistant Professor only Commerce Mr. M D PALANIVEL 12-05-1970 (ii) : : Category : OBC

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Applied for Subject opted for NET Name Date of Birth (as recorded in matriculation or equivalent certificate) (i) Sex : MALE Visually Challenged / Physically Challenged Father's Name

Affix recent Passport size Photograph signed by the candidate and duly attested by the Head of Deptt. / Institution or Class-I Gazetted Officer (DO NOT USE STAPLER OR PIN)

Not Applicable Shri M.DEVARAJAN

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8. 9.

Mother's Name Examination Appearing/Passed

: : : : : 555 : : : : Total Marks 24-10-2013 Paid

Smt. D.MURUGAMMAL M.Com. University of Madras Marks : 1000 Journal No. Mobile No. : Marks in % : : 55.5%

10. Name of the University/Institution 11. Marks/Grade Mark Obtained Deposit Date Fee Status 13. Candidate Phone No. 14. Email 12. Detail of Fee Deposited in State Bank of India

22687484

9842446429

mdpalanivel@gmail.com

Declaration
i) I, M D PALANIVEL, hereby declare that all statements made in the online application are true, complete and correct to the best of my knowledge and belief and in the event of any information being found false or incorrect or any ineligibility being detected before or after the test, my candidature is liable to be cancelled and legal action may be initiated against me. ii) I fulfill all conditions of eligibility regarding age limit, educational qualification etc. prescribed for the test. iii) I have gone through the conditions attached to NET and shall abide by the same. iv) I have deposited the required fee. v) I have noted that if my application is found incomplete/defective, the same is liable to be rejected summarily and no correspondence will be entertained in this regard. vi) I have read and agreed with the Notification for the UGC NET including instructions, enclosures, check list and other relevant information.

Date: 22-10-2013 Place: Chennai

___________________ Signature of Candidate

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