8/18/2015

CSIRUGCJRF/NETExam
Youmustcheckyourregistrationstatuswhenitisnotifiedonourwebsitecsirhrdg.res.in

(15D)

OnlineApplicationForm
JointCSIRUGCTestforJRF&LS(NET),December,2015
[CouncilofScientific&IndustrialResearchHRDGroup,ExaminationUnit]
1.RollNo(TobefilledbyOfficeOnly)

2.ApplicationNo.

15D647694
15D647694

3.AppliedFor

:01JRF

4.Subject

:5PHYPHYSICALSCIENCES

5.ExamCentre

:10GUWGUWAHATI

6.MeduimofNETExam(Asapplicable)

:02ENGLISH

7.CandidateName

:PRAGYANPHUKAN

8.Sex

:MALE

9.Father/Mother/HusbandName

:FATHER>HEMCHANDRAPHUKAN

10.DateOfBirth

:01011994

11.AgeAsOn01072015

:21Y,6M,0D

12.Category

:OBC

13.Physically/VisuallyHandicape(PH/VH)

:NA

14.IfVH,DoYouWantScribe'sHelp

:NA

15.WriteyournameandcompleteMailingAddress.
Name:

PRAGYANPHUKAN

Address:

KMH,TEZPURUNIVERSITY
NAPAAM

City:

SONITPUR

Pin:

784028

State:

ASSAM

SignatureofCandidate>

16.PermanentAddress
Name

:PRAGYANPHUKAN

Address

:C/OHEMCHANDRAPHUKAN
RATANPURGAON
City:DHEMAJJIPin:787057State:ASSAM

17.Email

:phukan.pragyan@gmail.com

Note:BachelorsdegreeholderswillnotbeeligibleforLectureship]
18.QualifyingDegree

:M.SC.

[CandidatesenrolledforM.Sc.orhavingcompleted10+2+3yearsofqualifyingexamination as given in column

18,mayapplyunderResultAwaited(RA)category]
19.IfResultAwaited

:RA

20.YearOfAppearinginFinalExam

:2016(IfResultAwaited)

21.GivedetailofFinalExamResult(IfnotResultAwaited)
(a)YearOfPassing:NA(b)Division:NA(c)MarkObtained(%):0%
22.IfenrolledinMSPhDprogram

:NO

(a)Yearofenrollment

:NA

(b)Yearofpassingbachelordegree

:NA

(c)Division/Grade

:NA

(d)MarksObtained(%)

:0

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CSIRUGCJRF/NETExam
ApplicationNo:

15D647694

23.Specialization:
(a)SpecializationCode:510(b)SpecializationSubjectName:HIGHENERGYPHYSICS
24(a)University/InstituteCode

:229

(b)University/InstituteName

:TEZPURUNIVERSITY,TEZPUR

DECLARATION
I,PRAGYANPHUKAN,herebydeclarethatallstatementsmadeinthisapplicationaretrue,completeand
correcttothebestofmyknowledgeandbeliefandintheeventofanyoftheinformationbeingfoundfalseorincorrect
oranyineligibilitybeingdetectedbeforeorafterthetestmycandidatureisliabletobecancelledandactioninitiated
againstme.
Ihavesubmittedonlyoneapplicationforthistest.
IfurtherdeclarethatIfulfillallconditionsofeligibilityregardingAgelimits,Educationalqualificationsetc.prescribedfor
thetest.
IalsodeclarethatIhaveneverbeenconvictedbyanycourtoflaw.
IdeclarethatIhavegonethroughtheconditionsattachedtoNETandshallabidebythesame.
I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike
whichisnotapplicable).
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)
I certify that the information given by the candidate Shri/Smt/Kum PRAGYAN PHUKAN has been verified by me with
referencetorecords.
Also this is certifiied that the candidate is enrolled for M.Sc. or having completed 10+2+3 years of (BS4
year/BE/B.Tech./B.Pharma/MBBS/Integrated BSMS or equivalent degree & is eligible to appear under 'RA" category as laid
downintheeligibilitycriteriaofadb[0].getAdv_title().(Strikewhichisnotapplicable)

SignatureoftheHeadofDept./Institute
Rubberstamp/seal
Name:

Designation:
NOTE : (Attestation should be signed by the Head of the Dept. or Institution where the candidate has appeared OR will be
appearingintheabovenotifiedQualification/DegreeExaminiationasapplicable).

25.ChallanDetail.
NameoftheBank
BranchCode
AmountinFigure(Rs.)
ChallanDate

:INDIANBANK
:1514
:500
:17/08/2015

Branch/City
JournalNo.
AmountinWord(Rs.)
Phone

:TEZPUR
:4000914
:FIVEHUNDRED
:9613066737

SignatureofApplicant
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./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
orbefore03092015(10092015forremoteareas).
PleasedonotstaplethehardcopyoftheApplicationform&enclosures.
Note:*******Nochangesintheapplicationformwillbeallowedaftersubmission*****

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CSIRUGCJRF/NETExam

CutandPastefollowingaddressonyourownenvelop(5X11)

(ApplicationforJointCSIRUGCTestforJRF&LS(NET),December,2015)
[5PHY|15D647694|10GUW|02ENGLISH]

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

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