(15D)

OnlineApplicationForm
JointCSIRUGCTestforJRF&LS(NET),December,2015
[CouncilofScientific&IndustrialResearchHRDGroup,ExaminationUnit]
1.RollNo(TobefilledbyOfficeOnly)

2.ApplicationNo.

15D660757

3.AppliedFor

:02LECTURERSHIP

4.Subject

:5PHYPHYSICALSCIENCES

5.ExamCentre

:25UDAUDAIPUR

6.MeduimofNETExam(Asapplicable)

:02ENGLISH

7.CandidateName

:MRIDULAMITTAL

8.Sex

:FEMALE

9.Father/Mother/HusbandName

:FATHER>SH.ASHOKMITTAL

10.DateOfBirth

:13051987

11.AgeAsOn01072015

:28Y,1M,18D

12.Category

:GEN

13.Physically/VisuallyHandicape(PH/VH)

:NA

14.IfVH,DoYouWantScribe'sHelp

:NA

15.WriteyournameandcompleteMailingAddress.
Name:

MRIDULAMITTAL

Address:

#1262/11,1,GANDHINAGAR

City:

MOGA

Pin:

142001

State:

PUNJAB

SignatureofCandidate>

16.PermanentAddress
Name
Address
17.Email

:MRIDULAMITTAL
:#1262/11,1,GANDHINAGAR
City:MOGAPin:142001State:PUNJAB
:mittal.mridula.14@gmail.com

Note:BachelorsdegreeholderswillnotbeeligibleforLectureship]
18.QualifyingDegree

:M.SC.

[CandidatesenrolledforM.Sc.orhavingcompleted10+2+3yearsofqualifyingexaminationasgivenincolumn
18,mayapplyunderResultAwaited(RA)category]
19.IfResultAwaited

:NO

20.YearOfAppearinginFinalExam

:NA(IfResultAwaited)

21.GivedetailofFinalExamResult(IfnotResultAwaited)
(a)YearOfPassing:2010(b)Division:FIRST(c)MarkObtained(%):69.8%
22.IfenrolledinMSPhDprogram

:NO

(a)Yearofenrollment

:NA

(b)Yearofpassingbachelordegree

:NA

(c)Division/Grade

:NA

(d)MarksObtained(%)

:0

ApplicationNo:

15D660757

23.Specialization:
(a)SpecializationCode:506(b)SpecializationSubjectName:ELECTRONICS
24(a)University/InstituteCode

:178

(b)University/InstituteName

:PANJABUNIVERSITY,CHANDIGARH

DECLARATION
I,MRIDULAMITTAL,herebydeclarethatallstatementsmadeinthisapplicationaretrue,completeand
correcttothebestofmyknowledgeandbeliefandintheeventofanyoftheinformationbeingfoundfalseorincorrect
oranyineligibilitybeingdetectedbeforeorafterthetestmycandidatureisliabletobecancelledandactioninitiated
againstme.
Ihavesubmittedonlyoneapplicationforthistest.
IfurtherdeclarethatIfulfillallconditionsofeligibilityregardingAgelimits,Educationalqualificationsetc.prescribedfor
thetest.
IalsodeclarethatIhaveneverbeenconvictedbyanycourtoflaw.
IdeclarethatIhavegonethroughtheconditionsattachedtoNETandshallabidebythesame.
I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike
whichisnotapplicable).
I understand that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be
entertainedbyCSIRinthisregard.
Date:
Place:
SignatureoftheCandidate.

ATTESTATION(For'RA'CategoryOnly)

NotApplicableForYouasYouhaveenteredRESULTAWAITEDas"NO"

25.ChallanDetail.
NameoftheBank
BranchCode
AmountinFigure(Rs.)
ChallanDate

:INDIANBANK
:2205
:1000
:18/08/2015

Branch/City
JournalNo.
AmountinWord(Rs.)
Phone

:MOTERA
:4081373
:ONETHOUSAND
:9464989975

SignatureofApplicant
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
(5X11) superscribing your subject code, application no., and centre code which should reach to the Deputy Secretary
(Exams),ExaminationUnit,HumanResourceDevelopmentGroup,CSIRComplex,LibraryAvenue,Pusa,NewDelhi110012on
orbefore11092015(18092015forremoteareas).
PleasedonotstaplethehardcopyoftheApplicationform&enclosures.
Note:*******Nochangesintheapplicationformwillbeallowedaftersubmission*****

CutandPastefollowingaddressonyourownenvelop(5X11)

(ApplicationforJointCSIRUGCTestforJRF&LS(NET),December,2015)
[5PHY|15D660757|25UDA|02ENGLISH]

To,
DeputySecretary(Exams)
ExaminationUnit,HumanResourceDevelopmentGroup
CSIRComplex,oppositeInstituteofHotelManagement,LibraryAvenue
Pusa,NewDelhi110012