Online Application Form

Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 19-12-2010 [Council of
Scientific & Industrial Research]HRD Group, Examination Unit

1. RollNo(To be filled by Office Only) 2. Application No.

10D610276
3. Applied For : 01 - JRF+LS
4. Subject : 3 - LIF - LIFE SCIENCES
5. Exam Centre : 01 - BAN - BANGALORE
6. Meduim of NET Exam(As
: ENGLISH
applicable)

7. Candidate Name : SOWMYA.

8. Sex : FEMALE
9. Father/Mother/Husband
: FATHER -> G.K.NAGARAJU
Name
10. Date Of Birth : 04-08-1988
11. Age As On 01-07-2010 : 21 Y, 10 M, 28 D
12. Category : OBC
13. Physically/Visually
: NA
Handicape(PH/VH)
14. If VH, Do You Want
: NA
Scribe's Help

15. Degree(M.Sc./Equivalent) : M.SC.

16. If Result Awaited : RA
17. Year Of Appearing in M.Sc.
: 2011
Final Exam
18. Give detail of M.Sc./Equivalent Final Exam Result
(a) Year Of Passing : NA
(b) Division : NA
(c) Mark Obtained (%) :0%
19. Specialization in M.Sc. :
(a) Specialization Code : 301
(b) Specialization Subject
: BIOCHEMISTRY
Name
20(a) University/Institute
: 156
Code
(b) University/Institute Name : UNIVERSITY OF MYSORE, MYSORE

21. Write your name and complete Mailing Address.

Name : SOWMYA.
Address : II M.SC, DOS IN BIOCHEMISTRY,
MANASAGANGOTRI,MYSORE

City : MYSORE
Pin : 570006
State : KARNATAKA
Signature of Candidate ------>

Application No: 10D610276

ermanent Address
: SOWMYA
: D.NO.364/2, NEAR TO GOVT. HOSPITAL,
K.M. DODDI(BHARATHINAGAR)
MADDUR TQ, MANDYA DIST
: MANDYA Pin : 571422 State :KARNATAKA

: kamakshinagaraju@gmail.com
 DECLARATION
I, SOWMYA., 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)

I certify that the information given by the candidate Shri/Smt/Kum SOWMYA. has been verified by
me with reference to records.

Also, this is certified that the candidate is in Final Year (III/IV Semester) of M.Sc. or equivalent
Degree and has appeared in Final Year (III/IV Semester)/is appearing in Final Year (III/IV
Semester) exam in academic session 2010-11.

Signature of the Head of Dept./Institute

Rubber stamp/seal
Name:
Designation:
NOTE : (Attestation should be signed by the Head of the Dept. or Institution where the candidate has
appeared OR will be appearing in M.Sc. Final or equivalent Degree Examination in academic
session 2010-11)..

(To be filled in by Applicant)

Name of the Bank : INDIAN BANK Branch/City :MYSORE
Branch Code : 00067 Journal No. : 1664065
Amount in
: 200 Amount in Word(Rs.) : TWO HUNDRED
Figure(Rs.)
Challan Date : 25/8/2010 Phone : 08232359291

Signature of Applicant
Note:Please send 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. only, as notified in the
Employment News/Website by arranging your own envelop (5”X11”) subscribing 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 03.09.2010 (09.09.2010 for remote areas).
Please do not staple the hard copy of the Application form & enclosures.