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in
(17D)
Online Application Form
Joint CSIR-UGC Test for JRF & LS(NET), December, 2017
[Council of Scientific & Industrial Research - HRD Group, Examination Unit]

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

17D823170 17D823170

3. Applied For : 03 - JRF-LECTURERSHIP


4. Subject : 1 - CHE - CHEMICAL SCIENCES
5. Exam Centre : 05 - CHA - CHANDIGARH
6. Meduim of NET Exam(As applicable) : 02-ENGLISH

7. Candidate's Name : CHETNA


[As mentioned in Matriculation Certificate]
8. Sex : FEMALE
9. (a) Father's Name : SURESH KUMAR
(b) Mother's Name : SUNITA RANI
(c) Husband's Name (if married) : NA
10. Date Of Birth : 26-06-1992
11. Age As On 01-07-2017 : 25 Y, 0 M, 6 D
[OBC category candidates not belonging to OBC (Non Creamy Layer) and whose caste is not listed in Central list
shall indicate their category as General]
12. Category : GEN
[For S.no. 13 and 14 below, only Persons with 40% and above disability(PwD) as per valid medical certificate
shall be considered]
13. Person with Disablity(PwD)? : NA
14. If PwD, Do you want scribe's help : NA

15. Write your name and complete Mailing Address.


Name: CHETNA
Address: #67,PATEL COLONY

City: RAJPURA
Pin: 140401
State: PUNJAB
Signature of Candidate ------>

16. Permanent Address


Name : CHETNA
: #67,PATEL COLONY
Address
City : RAJPURA Pin : 140401 State : PUNJAB
17. (a) Email : chetnashiv@gmail.com (b) Phone : NA (c) Mobile : 9779297690

Note:Bachelors degree holders will not be eligible for Lectureship]


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. (i) If Result Awaited : NO
(ii) Completion Date of 3rd year of course : NA
(iii) Enrollment Date in 4th year of course : NA
COLUMN 19(ii) & 19(iii) ARE MEANT ONLY FOR CANDIDATES PURSUING 4 YEAR DEGREE /MORE THEN 4 YR DEGREE/
INTEGRATED COURSES
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 : 2015 (b) Division : 1ST (c) Mark Obtained (%) : 60 %
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

Application No: 17D823170

23. Specialization :
(a) Specialization Code : 104 (b) Specialization Subject Name : PHYSICAL CHEMISTRY
24(a) University/Institute Code : 178
(b) University/Institute Name : PANJAB UNIVERSITY, CHANDIGARH

DECLARATION
I, CHETNA, 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/PwD (Persons with Disabilities), (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 :URBAN ESTATE,PATIALA
Branch Code : 2582 Journal No. : 005161290
Amount in Figure(Rs.) : 1000 Amount in Word(Rs.) : ONE THOUSAND
Challan Date : 19/09/2017 Phone : 9779297690

Signature of Applicant
Note:Please send hard copy of this ONLINE submitted application form duly signed with recent passport size 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 Deputy Secretary (Exams),
Examination Unit, Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi-110012 on or before 30-09-2017 (07-10-2017 for
remote areas).
Please do not staple the hard copy of the Application form & enclosures.
Cut and Paste following address on your own envelop(5X11)

(Application for Joint CSIR-UGC Test for JRF & LS(NET), December, 2017)
[1 - CHE | 17D823170 | 05 - CHA | 02-ENGLISH]

To,
Deputy Secretary (Exams)
Examination Unit, Human Resource Development Group
CSIR Complex,opposite Institute of Hotel Management, Library Avenue
Pusa, New Delhi-110012