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Online Application Form
Joint CSIRUGC Test for JRF & LS(NET), December, 2016
[Council of Scientific & Industrial Research HRD Group, Examination Unit]
1. RollNo(To be filled by Office Only) 2. Application No.
16D783873
3. Applied For : 01 JRF
4. Subject : 3 LIF LIFE SCIENCES
5. Exam Centre : 20 PUN PUNE
6. Meduim of NET Exam(As applicable) : 02ENGLISH
7. Candidate Name : SAINATH DNYANOBA GHORBAND
8. Sex : MALE
9. Father/Mother/Husband Name : FATHER > DNYANOBA VITTHAL GHORBAND
10. Date Of Birth : 05071992
11. Age As On 01072016 : 23 Y, 11 M, 26 D
12. Category : GEN
13. Physically/Visually Handicape(PH/VH) : NA
14. If VH, Do You Want Scribe's Help : NA
15. Write your name and complete Mailing Address.
Name: SAINATH DNYANOBA GHORBAND
Address: HOSTEL NO1, ROOM NO38,
INSTITUTE OF CHEMICAL TECHNOLOGY,
MATUNGA, MUMBAI
City: MUMBAI
Pin: 400019
State: MAHARASHTRA
Signature of Candidate >
16. Permanent Address
Name : SAINATH DNYANOBA GHORBAND
: AT POST BORGAON KIWLA,
Address TAL LOHA,
DIST NANDED City : NANDED Pin : 431707 State : MAHARASHTRA
17. Email : sainathghorband@gmail.com
Note:Bachelor’s degree holders will not be eligible for Lectureship]
18. Qualifying Degree : B.PHARMA.
[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. If Result Awaited : NO
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 : DISTINCTION (c) Mark Obtained (%) : 74.50 %
22. If enrolled in MSPhD program : NO
(a) Year of enrollment : NA
(b) Year of passing bachelor degree : NA
(c) Division/Grade : NA
(d) Marks Obtained (%) : 0
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9/16/2016 CSIRUGC JRF/NET Exam
Application No: 16D783873
23. Specialization:
(a) Specialization Code : 309 (b) Specialization Subject Name : PHARMACEUTICAL SCIENCE
24(a) University/Institute Code : 184
(b) University/Institute Name : UNIVERSITY OF PUNE, PUNE
DECLARATION
I, SAINATH DNYANOBA GHORBAND, 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/PH/VH (Physically or Visually handicapped), (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 :WADALA, MUMBAI
Branch Code : 00021 Journal No. : 5004670
Amount in Figure(Rs.) : 1000 Amount in Word(Rs.) : ONE THOUSAND
Challan Date : 14/09/2016 Phone : 9881373275
Signature of Applicant
Note:Please send hard copy of this ONLINE submitted application form duly signed with recent passport size Black & white
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
(5”X11”) 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 Delhi110012 on
or before 23092016 (30092016 for remote areas).
Please do not staple the hard copy of the Application form & enclosures.
Note: ******* No changes in the application form will be allowed after submission*****
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9/16/2016 CSIRUGC JRF/NET Exam
Cut and Paste following address on your own envelop(5”X11”)
(Application for Joint CSIRUGC Test for JRF & LS(NET), December, 2016)
[3 LIF | 16D783873 | 20 PUN | 02ENGLISH]
To,
Deputy Secretary (Exams)
Examination Unit, Human Resource Development Group
CSIR Complex,opposite Institute of Hotel Management, Library Avenue
Pusa, New Delhi110012
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