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UGC - NATIONAL ELIGIBILITY TEST JUNE, 2011

Print Copy of Application Form
(TO BE SUBMITTED TO THE TEST CENTRE IN DUPLICATE)

 
 

To be Filled by the Test Centre only

The particulars furnished by the
Roll No. 52170039 candidate have been checked and
verified
 
 
 
Ranchi University, Ranchi-834 008(52)
__________________________
UNIVERSITY TEST CENTRE  
CO-ORDINATOR (Signature)
Affix recent Passport size
  Photograph signed by the
  candidate and duly
Subject Code 17    attested by the Head of
Centre Code 52    the Deptt./Institution or
__________________________ Class I Gazetted Officer
OFFICE SEAL
(DO NOT USE STAPLER
OR PIN)
NET Examination Detail
 
  1. Applied for : JRF and Lectureship Both
 
2. (i) Post Graduation  
  : Appearing/Appeared in Final Year of PG
Examination
2. (ii) Subject of Post-
  : Management
Graduation
  3. Subject opted for NET : Management
  4. Centre of Examination : Ranchi University, Ranchi-834 008(52)
 
Personal Information
1. Name (as per Hr. Sec.
  : Mr. SAMBHU PRASSAN SAHU
Matriculation Certificate
6. (i) Date of Birth (as recorded
  in matriculation or : 06-01-1988
equivalent certificate)
  7. Sex : MALE
    Whether relaxation in
: No
age is sought
   8. Category : OBC
9. Visually Handicapped
  (V/H) / Physically : Not Applicable
Handicapped (PH)
10.
   Father's Name : Shri SHIV SHANKAR SAHU
(i)
10.
  Mother's Name : Smt. SHANTI DEVI
(ii)
11. Address for : AT-POST-SERAIKELLA,W.NO.2,NEAR-
Communication RCSA,POST OFFICE ROAD,
 
SERAIKELLA, JHARKHAND, INDIA,
833219
12. Permanent Address : AT-POST-SERAIKELLA,W.NO.2,NEAR-
RCSA,POST OFFICE ROAD,
 
SERAIKELLA, JHARKHAND, INDIA,
833219
 
Detail of Educational Qualification
  13. (a) Examination MBA    
Appearing/Passed :   Passed Ph. D.: No
  13. Name of the University :   Biju Patnaik University of
(b) Technology
  13. (c) Year of Passing :   NA
13. NA
Subject Offered :  
(d)
  13. (e) Specialization ( if any ) :   NA
  13. (f) Marks/Grade :   NA  
   Mark Obtained : NA
   Total Marks : NA
   % of marks obtained :  NA

 
  14.                      Detail of Fee Deposited
    Name of the Bank : STATE BANK OF INDIA
    Name of the Branch : chhend(Rourkela)
     Branch Code : 05157
    Journal No. : 008135282
        Deposit Date : 2011-03-20
    Amount : Rs. 225
 
The State/UT which you
  15. : Jharkhand(33)
belong
     
Phone No. (with STD
Place:   Seraikella
Code)
   
Date:    2011-04-16     Mobile No.: 7205361587
Email: sambhusrk@rediffmail.com    
 
Declaration
i) I, SAMBHU PRASSAN SAHU, hereby declare that all statement made in this application are true, complete and correct
to the best of my knowledge and belief and in 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.
ii) I fulfill all conditions of eligibility regarding age limit, educational qualification etc. prescribed for the test.
iii) I have gone through the conditions attached to NET and shall abide by the same.
iv) 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________________