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UGC - NATIONAL ELIGIBILITY TEST JUNE, 2012 Print Copy of Application Form
(TO BE SUBMITTED TO THE TEST CENTRE IN DUPLICATE)

To be Filled by the Test Centre only

Roll No. 90410

Cochin University of Science and Technology, Kochi-682 022(16) UNIVERSITY TEST CENTRE

The particulars furnished by the candidate have been checked and verified

__________________________ CO-ORDINATOR (Signature)

Subject Code Centre Code

01 16 __________________________ OFFICE SEAL

NET Examination Detail

1. 2. (i) 2. (ii) 3. 4. Applied for Post Graduation Examination Subject of Post-Graduation Subject opted for NET Centre of Examination : : : : : Lectureship only Passed Economics Economics Cochin University of Science and Technology, Kochi682 022(16)

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

Personal Information
5. 6. Name (as per Hr. Sec. Matriculation Certificate Date of Birth (as recorded in matriculation or equivalent certificate) Sex Whether relaxation in age is sought 8. 9. 10. (i) 10. (ii) 11. Category Visually Handicapped (V/H) / Physically Handicapped (PH) Father's Name Mother's Name Address for Communication : : : : : : Ms. MEGHA P.R

: : :

09-11-1988 FEMALE No OBC Not Applicable Shri RAVINDRAN P.M. Smt. RAGINI P. D. PONNAMPARA (H), KOORKENCHERY P.O.,KANNAMKULANGARA,KANNAMKULANGARA, TRICHUR, KERALA, INDIA, 680007

7.

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Permanent Address

PONNAMPARA (H), KOORKENCHERY P.O.,KANNAMKULANGARA,KANNAMKULANGARA, TRICHUR, KERALA, INDIA, 680007

Detail of Educational Qualification

13. (a) 13. (b) 13. (c) 13. (d) 13. (e) 13. (f) Examination Appearing/Passed : Name of the University : Year of Passing : Subject Offered : Specialization ( if any ) : Marks/Grade : MA Cochin University of Science and Technology 2011 MA Applied Economics Grade

CGPA : Maximum Grade Point : Percentage Equivalent : Whether your grade is equivalent to or higher than 50% marks (in case of SC/ST/VH/PH candidates) or 55% marks (in case of GEN/OBC candidates) :

7.45 10 70% Yes

Passed M. Phil: No 14.

Passed Ph. D.: No

Detail of Fee Deposited

Name of the Bank Name of the Branch Branch Code Journal No. Deposit Date Amount : : : : : : : STATE BANK OF INDIA Thrissur 0940 01532678 21-04-2012 Rs. 225 Kerala(12)

15.

The State/UT which you belong

Place: Date: Email:

Thrissur 23-04-2012 parukutti.ravi@gmail.com

Phone No. (with STD Code) Mobile No.: 9539416417

Declaration

) I, MEGHA P.R, hereby declare that all statement made in this application are true, complete and correct to the best of my knowledge and belief and n 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.

i) I fulfill all conditions of eligibility regarding age limit, educational qualification etc. prescribed for the test.

ii) I have gone through the conditions attached to NET and shall abide by the same.

v) 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 agree with the Notification for the UGC NET including instructions, enclosures, check list and other relevant information.

Signature of Candidate________________