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UGC - NATIONAL ELIGIBILITY TEST JUNE, 2013Print Copy of
Application Form
(ONE COPY TO BE SUBMITTED TO THE COORDINATING UNIVERSITY)
To be Filled by the Coordinating University only
Roll No.: 60020275
Ref.No.: 10464775
The particulars furnished by the candidatehave been checked and
verified
Utkal University, Bhubaneswar-751004(60)COORDINATING
UNIVERSITY
__________________________ CO-ORDINATOR (Signature )
Subject Code 02
Coordinating Uni versityCode
60 __________________________ OFFICE SEAL
1. Applied for : JRF and Lectureship Both
2. Subject opted for NET : Political Science
3. Name : Ms. RUPA RANI PIRI
4. Date of Birth (as recorded in matriculation
or equivalent certificate): 31-05-1991
5. (i) Sex : FEMALE (ii) Category : OBC
6. Visually Challenged / PhysicallyChallenged
: Not Applicable
7. Father's Name : Shri RASANANDA PIRI
8. Mother's Name : Smt. CHHABI RANI PIRI
9. Examination Appearing/Passed : MA
10. Nam e of the University/Ins titution : Utkal Univers ity
11. Marks/Grade : NAMark Obtained : NA Total Marks : NA Marks in
% : NA
Affix recent Passport sizePhotograph signed by the
candidate and dulyattested by the Head of
Deptt. / Institution or Class-I Gazetted Officer
(DO NOT USE STAPLEROR PIN)
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12. Detail of Fee Deposited in State Bank of India
Deposit Date : 03-05-2013Fee Status : Paid
Journal No. : 11444877
13. Candidate Phone No. : 06782250816 Mobile No. :
9124248409
14. Email : [email protected]
Declarationi) I, RUPA RANI PIRI , hereby declare that all
statements made in the online application are true, complete and
correct to the best of myknowledge and belief and in the event of
any information being found false or incorrect or any ineligibility
being detected before or after thetest, my candidature is liable to
be cancelled and legal action may be initiated against me. ii) I
fulfill all conditions of eligibility regarding agelimit,
educational quali fication etc. prescribed for the test. iii) I
have gone through the conditions attached to NET and shall abide by
the sam e.iv) I have deposited the required fee. v) I have noted
that if my application is found incomplete/defective, the same is
liable to be rejectedsummarily and no correspondence will be
entertained in this regard. vi) I have read and agreed with the
Notification for the UGC NETincluding ins tructions, enclosures ,
check list and other relevant information.
Date: 26-04-2013 ___________________ Place: Bhubaneswar
Signature of Candidate
