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APPLICATION FORMINDIAN COUNCIL FOR MEDICAL RESEARCH

DIVISION OF MANPOWER DEVELOPMENT, NEW DELHI

ICMR/JRF ENTRANCE EXAMINATION-2009

1. EXAMINATION CENTRE CODE01) Chandigarh, 02) Chennai, 03) Delhi

04) Kolkata, 05) Mumbai, 06) Hyderabad Code Name of the Centre07) Guwahati

2. STREAM CODE B) LIFE SCIENCESC) SOCIAL SCIENCES

Code Subject

3. CATEGORY ()

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-12payable atSBI, Medical Institute. code 1524)

5. NAME OF THE CANDIDATE ___________________________________Exactly as in XII or X Certificate in Bock Letters

6. FATHERs NAME ___________________________________

7. MOTHERS NAME ___________________________________

8. MARITAL STATUS MARRIED UNMARRIED OTHERS

9. DATE OF BIRTH:

DAY MONTH YEAR

10. AGE AS ON 30.09.2009Years 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 dispatchingadmit 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 _________________________________

Paste copy of recent

coloured passport

size photographattested with rubber

stamp/seal by the

Gazetted Officer

All the photographs

must be identical.

CLOSING DATE 29.04.2009

REMOTE AREA: 06.05.2009

DATE OF EXAM: 12.7.2009

(Tentative)

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INDIAN COUNCIL OF MEDICAL RESEARCH, NEW DELHIICMR/JRF ENTRANCE EXAMINATION-2009

CANDIDATES ATTENDANCE SHEET

1. Roll No. __________________(to be assigned by Office )

2. Category () Gen SC ST OBC PH

3. Stream Code () B) Life Sciences C) Social Sciences

4. Examination Centre:(Please mention code)

Chandigarh : 01Chennai : 02Delhi : 03Kolkata : 04Mumbai : 05Hyderabad : 06Guwahati : 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

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INDIAN COUNCIL OF MEDICAL RESEARCH, NEW DELHIICMR/JRF ENTRANCE EXAMINATION-2009

CANDIDATES ADMIT CARD

1. Roll NO. __________________

(To be assigned by Office)

2. Category (): Gen SC ST OBC PH

3. Stream Code () B) Life Sciences C) Social Sciences

4. Examination Centre:(Please Mention code)

Chandigarh : 01Chennai : 02Delhi : 03Kolkata : 04Mumba i : 05Hyderabad : 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.

REGISTRARPGIMER,CHD-12

Paste copy of recent

coloured passport

size photograph

attested with rubber

stamp/seal by the

Gazetted Officer

All the photographs

must be identical.

Paste copy of recent

coloured passportsize photograph

attested with rubber

stamp/seal by the

Gazetted Officer

All the photographs

must be identical.