PA Form

NATIONAL BRAIN RESEARCH CENTRE Application No.
_______
(Deemed University) (for official use only)
Manesar, Gurgaon-122 050, HARYANA.
Application form for Project Assistant
(please go through the instructions before filling up the application form)
1. Name ______________________________________________
2. Father’s Name ______________________________________________ Please attach a

recent, signed
3. Mother’s Name ______________________________________________ passport size
photograph. Do
4. Postal Address ______________________________________________ not staple.
______________________________________________
______________________ PIN-CODE ______________
5. Permanent Address ______________________________________________
______________________________________________
______________________ PIN-CODE ______________
6. Phone No. (if any, with STD Code) __________________________________
7. Email Address (if any) ____________________________________________
8. Date of Birth (DD / MM / YYYY) _____________________________________
9. Category SC* / ST* / OBC* / PH*/ General __ (*attach attested copy of the certificate)
10. Nationality ______________________________________________
11. Nearest Railway Station ___________________________________________
12. Educational Qualifications (Please attach detailed curriculum vitae along with attested copies in support of the
educational qualifications)
13) Names and addresses of 3 References along with reference letters-

1)
2)
3)
14) Whether attended PA interview in NBRC earlier - (Yes / No )
15) Application fees Rs.___________ Bank Draft No._____________ Dated: _____________

Name & Address of Issuing Bank ________________________________________________
16) Any Other Relevant Information (attach separate sheet, if required) _____________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
17) List of Enclosures:

1)_________________________ 2) _______________________ 3) ________________________
4) _________________________ 5) _______________________ 6) ________________________
7) _________________________ 8) _______________________ 9) ________________________
10) _______________________ 11) _______________________ 12) _______________________
18) Declaration: I understand that in the event of any information provided above being found
incorrect or misleading, my candidature shall be liable to cancellation by the NBRC at any time and I
shall not be entitled to refund of any fee paid by me to the NBRC.
Place: ___________
Date: ____________ Signature of the Candidate
INSTRUCTIONS FOR FILLING THE FORM
1. Application form should be filled in candidate’s own handwriting using blue/black ballpoint pen.
2. Item no. 1-4 should be filled in BLOCK letters.
3. Checklist of documents needs to be attached with the application form.
a. Demand draft [(Rs.100/- (non-refundable); no fee for SC/ST candidates)] drawn in favour
of Director, National Brain Research Centre, payable at Gurgaon / Manesar. Please
ensure that you have written your name and address on the backside of the demand
draft.
b. Attested copies of certificates in support of your educational qualifications.
c. Category certificate for SC/ST/physically challenged candidates.
d. Addresses of 3 References along with reference letters
4. Incomplete applications would be summarily rejected without giving any reason to the
candidate or entertaining any correspondence with him.
Completely filled in application form along with the requisite documents should be sent to “The
Registrar, National Brain Research Centre, NH-8, Manesar– 122050, Dist-Gurgaon, Haryana”.
The envelope containing the application form should be marked “Application Form for Project
Assistant.”

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NATIONAL BRAIN RESEARCH CENTRE Application No.

(please go through the instructions before filling up the application form)

2. Father’s Name ______________________________________________ Please attach a

________ PIN-CODE

5. Permanent Address ______________________________________________

________ PIN-CODE

6. Phone No. (if any, with STD Code) __________________________________

7. Email Address (if any) ____________________________________________

8. Date of Birth (DD / MM / YYYY) _____________________________________

10. Nationality ______________________________________________

11. Nearest Railway Station ___________________________________________

13) Names and addresses of 3 References along with reference letters-

14) Whether attended PA interview in NBRC earlier - (Yes / No )

15) Application fees Rs._____ Bank Draft No._ Dated: _______

17) List of Enclosures:

INSTRUCTIONS FOR FILLING THE FORM

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