You are on page 1of 2

CSIR-UGC JRF/NET Exam http://115.112.95.106/jrf/online/submit_form.

jsp

(13D)
Online Application Form
Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 22-12-2013
[Council of Scientific & Industrial Research - HRD Group, Examination Unit]

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

13D758290

3. Applied For : 01 - JRF


4. Subject : 1 - CHE - CHEMICAL SCIENCES
5. Exam Centre : 02 - BHA - BHAVNAGAR
6. Meduim of NET Exam(As applicable) : 01-HINDI

7. Candidate Name : BARDOLIA DIPESH RASHMIKANTBHAI


8. Sex : MALE
9. Father/Mother/Husband Name : FATHER -> BARDOLIA RASHMIKANT MUGATLAL
10. Date Of Birth : 18-12-1988
11. Age As On 01-07-2013 : 24 Y, 6 M, 13 D
12. Category : GEN
13. Physically/Visually Handicape(PH/VH) : NA
14. If VH, Do You Want Scribe's Help : NA

15. Write your name and complete Mailing Address.


Name: BARDOLIA DIPESH RASHMIKANTBHAI
Address: H.NO.817, KUMBHARWAD KATARGAM,
OPPOSITE INDRAPRASTH APPT,
SURAT-395004
City: SURAT
Pin: 395004

State: GUJARAT
Signature of Candidate ------>

16. Permanent Address


Name : BARDOLIA DIPESH RASHMIKANTBHAI
: H.NO.817, KUMBHARWAD KATARGAM,
Address OPPOSITE INDRAPRASTH APPT,
SURAT-395004 City : SURAT Pin : 395004 State : GUJARAT
17. Email : dipeshbardolia@gmail.com

18. Qualifying Degree : M.SC.


[Candidates enrolled for M.Sc. or having completed 10+2+3 years of qualifying examination as given in column 18,
may apply under Result Awaited (RA) category]
19. If Result Awaited : NO
20. Year Of Appearing in Final Exam : NA (If Result Awaited)
21. Give detail of Final Exam Result (If not Result Awaited)
(a) Year Of Passing : 2013 (b) Division : FIRST (c) Mark Obtained (%) : 63.17 %
22. If enrolled in MS-PhD program : NO
(a) Year of enrollment : NA
(b) Year of passing bachelor degree : NA
(c) Division/Grade : NA
(d) Marks Obtained (%) :0

1 of 3 20-08-2013 11:58 AM
CSIR-UGC JRF/NET Exam http://115.112.95.106/jrf/online/submit_form.jsp

Application No: 13D758290

23. Specialization :
(a) Specialization Code : 105 (b) Specialization Subject Name : ENVIRONMENTAL CHEMISTRY
24(a) University/Institute Code : 212
(b) University/Institute Name : SOUTH GUJARAT UNIVERSITY, SURAT

DECLARATION
I, BARDOLIA DIPESH RASHMIKANTBHAI, 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)

Not Applicable For You as You have entered RESULT AWAITED as "NO"

25. Challan Detail.


Name of the Bank : INDIAN BANK Branch/City :ADAJAN
Branch Code : 01694 Journal No. : 001700011
Amount in Figure(Rs.) : 400 Amount in Word(Rs.) : FOUR HUNDRED
Challan Date : 19/08/2013 Phone : 09033127628

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./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 Sr. Controller of Examination, Examination Unit,
Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi-110012 on or before 27-08-2013
(02-09-2013 for remote areas).
Please do not staple the hard copy of the Application form & enclosures.

2 of 3 20-08-2013 11:58 AM

You might also like