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Online Application Form

Joint CSIR-UGC Test for JRF & LS(NET), June, 2019
[Council of Scientific & Industrial Research - HRD Group, Examination Unit]
(Only Indian Nationals Can Apply)

Application No.
19J6263175 19J6263175

[A] JRF/NET Option Details

1. Apply for JRF or LS : 1 - JUNIOR RESEARCH FELLOWSHIP(JRF)

2. Subject : 5 - PHY - PHYSICAL SCIENCES

3. Specialization:

(a) Specialization Code : 509

(b) Specialization Name : THERMODYNAMICS

4. Exam Centre : 17 - KOL - KOLKATA

5. Medium of Exam(As applicable) : 02-ENGLISH

[B] Personal Details

[As mentioned in Matriculation Certificate]

1. Name of the Candidate : Mr. SOUMYAJYOTI DEY

2. Email Address : TATAIDEY5@GMAIL.COM

3. Mobile Number : +91-7338957086

4. Phone : 9884204668

5. Gender : MALE

6. Father's Name : SUDARSAN DEY

7. Mother's Name : JAYA DEY

8. Husband's Name (in case of married female) : NA

9. Date Of Birth : 17-01-1998

Age As On 01-01-2019 : 20 Y, 11 M, 15 D

[OBC candidates whose caste is listed only in the State List and not listed in Central List are not eligible to
apply under OBC category and have to apply as General category candidates]

10. Category : GEN

[For S.no. 11 and 12 below, only Persons with 40% or more disability(PwD) as per valid medical certificate
shall be considered]

11. Person with Disablity(PwD)? : NA

12. If PwD, do you require scribe? : NA

[C] Name and complete Mailing Address [Please refer Information Bulletin]

1. Name : Mr. SOUMYAJYOTI DEY

2. Address : 295,P.MAJUMDER,ROAD.'PRANTIK' FLAT NO-302

3. City        : KOLKATA 4. Pin : 700078 5. State : WEST BENGAL

[D] Permanent Address

1. Name : Mr. SOUMYAJYOTI DEY

2. Address : 295,P.MAJUMDER,ROAD.'PRANTIK' FLAT NO-302

3. City        : KOLKATA 4. Pin : 700078 5. State : WEST BENGAL

[E] Qualifying Degree Details [Please refer Information Bulletin]

[Bachelor's degree holders will not be eligible for Lectureship, as per instructions contained in Information
Bulletin]

Qualifying Degree : B.TECH.

[Candidates enrolled for M.Sc. or having completed 10+2+3 years of qualifying examination, may apply
under Result Awaited (RA) category]
In case the candidates are awarded grades/CGPA instead of marks, the conversion of grades/CGPA to
percentage/ marks would be based on the conversion formula certified by the university/institution from
where the candidate has obtained their degrees.

► Qualifying Degree Details

1. Month & Year of Enrollment : 06-2015

2. Duration In Year : 4.0

3. University/Institute : SRM INSTITUTE OF SCIENCE AND TECHNOLOGY

4. If Result Awaited (RA) : YES

► 6th Semester / 3rd Year Details

1. Month & Year of Passing : 05-2018

2. Percentage (%) : 77.75%

3. Obtained Marks : 77.75

4. Maximum Marks : 100

► 7th Semester / 4th Year Details

1. Month & Year of Enrollment : 06-2018

2. Likely Year of Passing in Final : 2019

Semester/Final Year

[F] Uploaded Documents

► Qualifying final/last Marksheet :✔

► Attested Certificate [if RA (Yes)] :✔

[G] Fee Details

1. Amount in Figure(Rs.) : 1000.00

2. Amount in Word : RUPEES ONE THOUSAND ONLY

3. Fee Status : SUCCESS

4. Reference No. : QSBI7335823303

5. Payment Date : 2019-03-17 22:05:43

[H] DECLARATION

I, Mr. SOUMYAJYOTI DEY, a citizen of India have read and understood the instructions
contained in the Information Bulletin and 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
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 further declare that I fulfil 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 uploaded self attested copies of certificate of being SC/ST/OBC/PwD (Persons with
Disabilities)/Qualifying Degree MarkSheet(As 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.
I understand that mere submission of online application is not a criterion for selection. Online
application system is meant for capturing application data with maximum possible validation
rules to assist in filling up online application. It is my responsibility to preview the application
for correctness before final submission. At any stage of the exam process, if it is found that I
do not fulfill any of the laid down eligibility criteria, my candidature will stand cancelled.

Date: 2019-03-17
22:05:43

Signature of Applicant