8/7/2014 CSIR-UGC JRF/NET Examhttp://59.163.216.82:8080/jrf/online/submit_form.jsp 1/3You must check your registration status when it is notified on our website csirhrdg.res.in(14D)Online Application FormJoint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 21-12-2014 [Council of Scientific & Industrial Research - HRD Group, Examination Unit]1. RollNo(To be filled by Office Only) 2. Application No.14D6997983. Applied For : 01 - JRF4. Subject : 6 - ENG - ENGINEERING SCIENCES5. Exam Centre : 08 - DEL - DELHI6. Meduim of NET Exam(As applicable) : 02-ENGLISH 7. Candidate Name : GAUTAM KUNAL8. Sex : MALE9. Father/Mother/Husband Name : FATHER -> ASHOK KUMAR VARMA10. Date Of Birth : 25-12-198811. Age As On 01-07-2014 : 25 Y, 6 M, 6 D12. Category : OBC13. Physically/Visually Handicape(PH/VH) : NA14. If VH, Do You Want Scribe's Help : NA 15. Write your name and complete Mailing Address.Name: GAUTAM KUNALAddress: C/O SHISHMANI KUMARI STAFF NURSER H S COMPLEX DENDUAPO SALANPURCity: BURDWANPin: 713357State: WEST BENGALSignature of Candidate ------> 16. Permanent Address Name : GAUTAM KUNALAddress: C/O ASHOK KUMAR VERMAHNO 40 VILL INDAUT PO BHAWANBARUIHILSACity : NALANDAPin : 801302 State : BIHAR17. Email : gautamkunalworld@gmail.com Note:Bachelors degree holders will not be eligible for Lectureship]18. Qualifying Degree : B.TECH.[Candidates enrolled for M.Sc. or having completed 10+2+3 years of qualifying examination as given in column18, may apply under Result Awaited (RA) category]19. If Result Awaited : NO20. 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 (%) : 73.50 %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 (%) : 08/7/2014 CSIR-UGC JRF/NET Examhttp://59.163.216.82:8080/jrf/online/submit_form.jsp 2/3Application No: 14D69979823. Specialization :(a) Specialization Code : 605(b) Specialization Subject Name : ELECTRONICS AND COMMUNICATIONENGINEERING24(a) University/Institute Code: 165(b) University/Institute Name : NATIONAL INSTITUTE OF TECHNOLOGY DECLARATIONI, GAUTAM KUNAL, hereby declare that all statements made in this application are true, complete andcorrect to the best of my knowledge and belief and in the event of any of the information being found false or incorrector any ineligibility being detected before or after the test my candidature is liable to be cancelled and action initiatedagainst 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 forthe 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 whichis not applicable).Iunderstandthatmyapplicationwillberejectedsummarilyiffoundincomplete/ineligible,andnocorrespondencewillbeentertained 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 :MALVIYA NAGAR DELHIBranch Code : 1908 Journal No. : 900485Amount in Figure(Rs.) : 200 Amount in Word(Rs.) : TWO HUNDREDChallan Date : 07/08/2014 Phone : 8447320663 Signature of ApplicantNote:Please sendhardcopyofthisONLINEsubmittedapplicationformdulysignedwithrecentpassportsizeBlack&whitephotographalongwithacopyoforiginalchallan(feedepositreceipt)meantforCSIR(ExaminationUnit)withrequiredcertificate(s)byU.P.C./ordinaryPostonly,asnotifiedintheEmploymentNews/Websitebyarrangingyourownenvelop(5X11)superscribingyoursubjectcode,applicationno.,andcentrecodewhichshouldreachtotheSr.ControllerofExamination, Examination Unit, Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi-110012on or before 19-08-2014 (25-08-2014 for remote areas).Please do not staple the hard copy of the Application form & enclosures.8/7/2014 CSIR-UGC JRF/NET Examhttp://59.163.216.82:8080/jrf/online/submit_form.jsp 3/3(Application for Joint CSIR-UGC Test for JRF/LS (NET), December, 2014) [6 - ENG | 14D699798 | 08 - DEL | 02-ENGLISH]To,Sr. Controller of Examinations Examination Unit, Human Resource Development GroupCSIR Complex,opposite Institute of Hotel Management, Library AvenuePusa, New Delhi-110012Cut and Paste following address on your own envelop(5X11)