(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. R ollNo(To be fille d by O ffice O nly)

2. Application No.

13D683135
3. Applie d For

: 02 - LECTURERSHIP

4. Subje ct

: 3 - LIF - LIFE SCIENCES

5. Ex am C e ntre

: 16 - KOL - KOLKA TA

6. Me duim of NET Ex am (As applicable )

: 02-ENGLISH

7. C andidate Nam e

: MITA SA HA NA

8. Se x

: FEMA LE

9. Fathe r/Mothe r/Husband Nam e

: FA THER -> DULA L SA HA NA

10. Date O f Birth

: 11-06-1986

11. Age As O n 01-07-2013

: 27 Y, 0 M, 21 D

12. C ate gory

: GEN

13. Physically/Visually Handicape (PH/VH)

: NA

14. If VH, Do You W ant Scribe 's He lp

: NA

15. W rite your nam e and com ple te Mailing Addre ss.
Nam e :

MITA SA HA NA

Addre ss:

VILL + POST SA NTA

SA HA NA PA RA NEA R DURGA MA NDIR
VIA BURNPUR PS HIRA PUR DIST BURDWA N

C ity:

BURNPUR

Pin:

713325

State :

WEST BENGA L
Signature of C andidate ------>

16. Pe rm ane nt Addre ss

Nam e

: MITA SA HA NA

Addre ss

: VILL + POST SA NTA

SA HA NA PA RA NEA R DURGA MA NDIR
VIA BURNPUR PS HIRA PUR DIST BURDWA N
AL

17. Em ail

: mita.sahana8@gmail.com

18. Q ualifying De gre e

C ity : BURNPUR

Pin : 713325

State : WEST BENG

: M.TECH (W.BUT) BIO-TECHNOLOGY

[Candidates enrolled for M.Sc. or having completed 10+2+3 years of qualifying examination as given in column
18, may apply under Result A waited (RA ) category]
19. If R e sult Awaite d

: NO

20. Ye ar O f Appe aring in Final Ex am

: NA

(If R e sult Awaite d)

21. Give de tail of Final Ex am R e sult (If not R e sult Awaite d)

(a) Ye ar O f Passing : 2012

(b) Division : 1ST CLA SS

22. If e nrolle d in MS-PhD program

: NO

(a) Ye ar of e nrollm e nt

: NA

(b) Ye ar of passing bache lor de gre e

: 2006

(c) Division/Grade

: 2ND CLA SS

(d) Mark s O btaine d (%)

: 56

(c) Mark O btaine d (%) : 90 %

Application No:

13D683135

23. Spe cialization :

(a) Spe cialization C ode : 303

(b) Spe cialization Subje ct Nam e : BIOTECHNOLOGY

24(a) Unive rsity/Institute C ode

: 999

(b) Unive rsity/Institute Nam e

: WEST BENGA L UNIVERSITY OF TECHNOLOGY

DECLA RA TION
I, MITA SA HA NA , he re by de clare that all state m e nts m ade in this application are true , com ple te and
corre ct to the be st of m y k nowle dge and be lie f and in the e ve nt of any of the inform ation be ing found false or
incorre ct
or any ine ligibility be ing de te cte d be fore or afte r the te st m y candidature is liable to be cance lle d and action
initiate d
against m e .
I have subm itte d only one application for this te st.
I furthe r de clare that I fulfill all conditions of e ligibility re garding Age lim its, Educational qualifications e tc.
pre scribe d for
the te st.
I also de clare that I have ne ve r be e n convicte d by any court of law.
I de clare that I have gone through the conditions attache d to NET and shall abide by the sam e .
I have e nclose d the atte ste d copie s of ce rtificate of be ing SC /ST/O BC /PH/VH (Physically or Visually handicappe d),
(strik e which is not applicable ).
I unde rstand that m y application will be re je cte d sum m arily if found incom ple te /ine ligible , and no corre sponde nce
will be e nte rtaine d by C SIR in this re gard.
Date :
Place :
Signature of the C andidate .
A TTESTA TION(For 'RA ' Category Only)

Not Applicable For You as You have e nte re d R ESULT AW AITED as "NO "
25. C hallan De tail.
Nam e of the Bank
Branch C ode
Am ount in Figure (R s.)
C hallan Date

: INDIA N BA NK
: 019598
: 400
: 16/08/2013

Branch/C ity
Journal No.
Am ount in W ord(R s.)
Phone

:A SA NSOL
: 1744996
: FOUR HUNDRED
: 8759475518

Signature of Applicant
Note:Ple ase se nd hard copy of this O NLINE subm itte d application form duly signe d with re ce nt passport size Black &
white photograph along with a copy of original challan (fe e de posit re ce ipt) m e ant for C SIR (Ex am ination Unit) with
re quire d ce rtificate (s) by U.P.C ./ordinary Post only, as notifie d in the Em ploym e nt Ne ws/W e bsite by arranging your
own e nve lop (5X11) supe rscribing your subje ct code , application no., and ce ntre code which should re ach to the
Sr. C ontrolle r of Ex am ination, Ex am ination Unit, Hum an R e source De ve lopm e nt Group, C SIR C om ple x , Library
Ave nue , Pusa, Ne w De lhi-110012 on or be fore 27-08-2013 (02-09-2013 for re m ote are as).
Please do not staple the hard copy of the A pplication form & enclosures.

Cut and Paste following address on your own envelop(5X11)

(Application for Joint CSIR-UGC Test for JRF/LS (NET), December, 2013)
[3 - LIF | 13D683135 | 16 - KOL | 02-ENGLISH]

To,
Sr. Controller of Examinations
Examination Unit, Human Resource Development Group
CSIR Complex,opposite Institute of Hotel Management, Library Avenue
Pusa, New Delhi-110012