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    Application Form: Icmr/Jrf Entrance Examination-2009

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    drranjanabt
    This document contains an application form for the Indian Council of Medical Research Junior Research Fellowship (ICMR/JRF) entrance examination scheduled for July 12, 2009. The form requests information such as the applicant's personal details, education qualifications, exam registration details, and a declaration agreeing to abide by the exam rules. It also includes an attendance sheet and admit card to be filled out on the exam date.

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    Application Form: Icmr/Jrf Entrance Examination-2009

    Uploaded by

    drranjanabt
    21 views3 pages
    This document contains an application form for the Indian Council of Medical Research Junior Research Fellowship (ICMR/JRF) entrance examination scheduled for July 12, 2009. The form requests information such as the applicant's personal details, education qualifications, exam registration details, and a declaration agreeing to abide by the exam rules. It also includes an attendance sheet and admit card to be filled out on the exam date.

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    jicmrrf_form1

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    This document contains an application form for the Indian Council of Medical Research Junior Research Fellowship (ICMR/JRF) entrance examination scheduled for July 12, 2009. The form requests information such as the applicant's personal details, education qualifications, exam registration details, and a declaration agreeing to abide by the exam rules. It also includes an attendance sheet and admit card to be filled out on the exam date.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    21 views3 pages

    Application Form: Icmr/Jrf Entrance Examination-2009

    Uploaded by

    drranjanabt
    This document contains an application form for the Indian Council of Medical Research Junior Research Fellowship (ICMR/JRF) entrance examination scheduled for July 12, 2009. The form requests information such as the applicant's personal details, education qualifications, exam registration details, and a declaration agreeing to abide by the exam rules. It also includes an attendance sheet and admit card to be filled out on the exam date.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    Download as pdf or txt
    of 3

    CLOSING DATE 29.04.

    2009
    REMOTE AREA: 06.05.2009
    APPLICATION FORM
    INDIAN COUNCIL FOR MEDICAL RESEARCH DATE OF EXAM: 12.7.2009
    (Tentative)
    DIVISION OF MANPOWER DEVELOPMENT, NEW DELHI

    ICMR/JRF ENTRANCE EXAMINATION-2009

    1. EXAMINATION CENTRE CODE Paste copy of recent


    01) Chandigarh, 02) Chennai, 03) Delhi coloured passport
    04) Kolkata, 05) Mumbai, 06) Hyderabad Code Name of the Centre size photograph
    07) Guwahati attested with rubber
    stamp/seal by the
    2. STREAM CODE B) LIFE SCIENCES Gazetted Officer
    C) SOCIAL SCIENCES
    Code Subject All the photographs
    3. CATEGORY (√) must be identical.

    i) General ii) Scheduled Caste iii) Scheduled Tribe


    iv) Other Backward Classes v) Physically Handicapped

    4. Draft No.________________ Date ______________ Amount _______________

    Name of Issuing Branch ________________________

    (Draft (Rs.500/- for General/OBC and Rs.300/- for SC/ST/PH) should be in favour of Director, PGI, CHD-12 payable at
    SBI, Medical Institute. code 1524)

    5. NAME OF THE CANDIDATE ___________________________________


    Exactly as in XII or X Certificate in Bock Letters

    6. FATHER’s NAME ___________________________________

    7. MOTHER’S NAME ___________________________________

    8. MARITAL STATUS MARRIED UNMARRIED OTHERS

    9. DATE OF BIRTH:

    DAY MONTH YEAR

    10. AGE AS ON 30.09.2009


    Years Months Days
    11. SEX (M / F)

    12. PRESENT POSTAL ADDRESS


    (Do not repeat name as filled in COLUMN 5 & 6 Please mention complete postal address to avoid delay in dispatching
    admit cards)

    HOUSE No. /STREET NO. __________________________________


    CITY __________________________________
    DISTRICT/ STATE (with pin code) __________________________________
    STD CODE - TELEPHONE NO __________________________________
    EMAIL ADDRESS _________________________________

    13. PERMANENT ADDRESS:


    HOUSE No. /STREET NO. __________________________________
    CITY __________________________________
    DISTRICT/ STATE (with pin code) __________________________________
    STD CODE - TELEPHONE NO _________________________________

    1
    14. (I) GIVE DETAILS OF QUALIFYING DEGREE (M.Sc./M.A./Equivalent)

    (a) Year of passing (b) Division (c) % of marks

    (II) YEAR OF APPEARING/HAS APPEARED /RESULT AWAITED (IN M.Sc./M.A./Equivalent)


    Attach appearing certificate from the Head of the Institution
    Month Year
    (1) Result awaited
    (2) Result declared
    (Mention 1 or 2)

    15. NAME OF THE UNIVERSITY /INSTITUTE AWARDING THE DEGREE:

    _______________________________________________________________________________

    DECLARATION
    I……………………………………………..………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 not been convicted by any court of law.

    I declare that I have gone through the conditions attached to JRF examination of ICMR and shall abide by the same.

    I have enclosed Demand Draft for fee and the attested copies of certificates of SC/ST/OBC/PH, strike whichever is not
    applicable.

    I have noted that my application will be rejected summarily, if found incomplete/defective, and no correspondence will be
    entertained in this regard.

    I hereby declare that in case I am unable to send the M.Sc. /MA Final Marks Sheet latest by 30.09.2009, my candidature will deem
    to be rejected without further correspondence.

    IMPORTANT: PLEASE ENCLOSE A SELF ADDRESSED STAMPED ENVELOPE BEARING STAMPS OF RS. 10/-

    Date ………………..

    Place .........………… (Signature of the candidate)

    ATTESTATION

    (By Head of the Institution from where the candidate has appeared OR will be appearing in M.Sc., MA Final
    Examination of 2008-2009)

    I certify that the information given by the candidate Sh./Smt./Kumari ……………………………………………..………has


    been checked by me and it is certified that the candidate is appearing/has appeared in M.Sc. /MA. (IV/VI Semester
    whichever is applicable). In the final exam of the year 2008-2009 but result awaited vide roll
    number_______________.

    Date ……………….. Name and signature of the Head of Institute

    Place .........…………

    Rubber Stamp / Seal

    2
    INDIAN COUNCIL OF MEDICAL RESEARCH, NEW DELHI
    ICMR/JRF ENTRANCE EXAMINATION-2009
    CANDIDATE’S ATTENDANCE SHEET

    1. Roll No. __________________


    (to be assigned by Office )
    Paste copy of recent
    2. Category (√) Gen SC ST OBC PH coloured passport
    size photograph
    3. Stream Code (√) B) Life Sciences C) Social Sciences attested with rubber
    stamp/seal by the
    4. Examination Centre: Gazetted Officer
    (Please mention code)
    All the photographs
    Chandigarh : 01 must be identical.
    Chennai : 02
    Delhi : 03
    Kolkata : 04
    Mumbai : 05
    Hyderabad : 06
    Guwahati : 07

    5. Specimen Signature of the Candidate ______________________

    NOTHING TO BE WRITTEN BELOW THIS LINE BY THE CANDIDATE

    ________________ __________________ _____________________


    Date and Time Signature of Candidate Signature of Invigilator

    ==================================================================

    INDIAN COUNCIL OF MEDICAL RESEARCH, NEW DELHI


    ICMR/JRF ENTRANCE EXAMINATION-2009
    CANDIDATE’S ADMIT CARD
    1. Roll NO. __________________
    Paste copy of recent
    (To be assigned by Office)
    coloured passport
    size photograph
    2. Category (√): Gen SC ST OBC PH attested with rubber
    stamp/seal by the
    3. Stream Code (√) B) Life Sciences C) Social Sciences Gazetted Officer

    4. Examination Centre: All the photographs


    (Please Mention code) must be identical.

    Chandigarh : 01
    Chennai : 02
    Delhi : 03
    Kolkata : 04
    Mumba i : 05
    Hyderabad : 06
    Guwahati : 07

    5. Specimen Signature of the Candidate ______________________

    Please admit Ms. /Mr. ________________________________ whose photograph along with the specimen
    signature is affixed thereon to the ICMR-JRF entrance examination-2009 mentioned above.

    REGISTRAR
    PGIMER,CHD-12
    3

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