7/26/2019 Application Form RTF-DCS 2016-17

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Please (i) TAKE A PRINTOUT OF THE FORM; (ii) FILL UP DETAILS BY TYPING OR IN CAPITALLETTERS; (iii) SCAN; and (i) SEND TO US AS ATTACHMENT TO YOUR EMAIL !i"# all en$l%s&'es

N% $%l&n s#%&ld e le*" lan+,

Last date for submission of completed Application Form: Friday, 17th June 2016

S!"#$% & A: '(S$%AL )"A#LS

1.Name (Dr./Mr./Mrs./Ms.)(As in Passport)

Affi*(ecent

'hoto+raph

2.Designation(Present position)

3. Nationality

4. Date of Birth

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Plae of Birth (!ity)

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!o"ntry

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#. Passport No

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Plae of iss"e

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Date of $ss"e

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%ali& "p to

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'. Name of the $nstit"tionhere employe&

ffie A&&ress

Phone

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*a+

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,mail

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. esi&ential A&&ress

Moile(0ith !o"ntry

!o&e)

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Phone(0ith !o"ntry /Area !o&e)

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*a+(0ith !o"ntry /Area !o&e)

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,mail

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. ,&"ational "alifiationsighest Degree 5ni6ersity

7ear of Aar& *iel& of 8t"&y

9. Please attach yo"r !"rri"l"m %itae (a*imum t-o 'a+es): inl"&ing Professional an& esearh

,+periene an& a list of Ma+im"m *i6e eent 8ientifi P"liations in separate sheets asAnne-&'e . /1; a6e yo" a6aile& any other *elloship in $n&ia earlier< $f yes: rite the Name/7ear of the *elloship a6aile&

an& instit"tion in hih or=e&.

Date >>>>>>>>>>>>>>>>> 8ignat"re of appliant

Plae >>>>>>>>>>>>>>>>>

S!"#$% & .: %)$(S%" $F '(S%" 'L$/(

APPLICATION FORM

Centre for Science and Technology of the Non-Aligned& Other Develoing Co!ntrie" #NAM S&T Centre$

R%S%ARC TRAININ' F%LLO(SIPFOR D%)%LOPIN' CO*NTR+ SCI%NTISTS #RTF-DCS$

7/26/2019 Application Form RTF-DCS 2016-17

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?he appliation of Dr./Mr./Mrs./Ms.@@@@@@@@@@@@@@@@for the (esearch "rainin+ Fello-ship for

)eelopin+ !ountry Scientists ("F)!S3 in $n&ia is reommen&e& for onsi&eration y the NAM 8? !entre.

$f selete&: Dr./Mr./Mrs./Ms. @@@@@@@@@@..@.ill e santione& lea6e for the *elloship perio& an& ill

oin his/her &"ties a= in this rganisation on ompletion of the *elloship perio& in $n&ia

Name of the reommen&ing offier (in *"ll) >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Designation >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Plae_________________ 8ignat"re >>>>>>>>>>>>>>>>>>>

Date _________________ 8eal

S!"#$% & !: (SA(!4 '($'$SALBroa& Disipline/8"et of Propose&esearh ('lease tic5 any one) (Pl. see8etion-%$ P C 2 of the Anno"nement)

Agri"lt"ral 8ienes Biologial an&Me&ial 8ienes

!hemial 8ienes

Physial 8ienesan& Mathematis

,arth 8ienes ,ngineering 8ienes

Materials: Mineralsan& Metall"rgy

M"lti-&isiplinary an&ther Areas

?itle of the esearh Proposal Attah a&etaile& esearh Proposal itheti6es: 8ope of 0or=: Plan of Ation:Metho&ology and Deli6eralesin separatesheets asAnne-&'e 0 12

Area of Propose& esearh (Pi= fromenlose& list of instit"tions or as peronsent from any other instit"tion: ifotaine&)

#f an #ndian scientistinstitution has already accepted you to -or5 there, please gi6e the name an& ontat&etails: inl"&ing e. mail a&&ress: phone nos. et. of the sientist/instit"tionE $n this ase: a opy of the onsent

letter sho"l& e attahe& ith the appliation.!hec5 List for nclosures to be attached -ith your mail 8in separate files9:

i. Application Form: ompletely fille& in itho"t lea6ing any lan= ol"mn in ?yperitten or !apital Fetters ith a passporsize photograph (Paste on the space given before scanning the application) and Endorsement from the Employer in the

Application Form; To be scanned and attached with the Email

ii. 'assport - !opy of rele6ant pages of the Passport.

iii. !- !"rri"l"m %itae (Ma+im"m to Pages): $nl"&ing Professional an& esearh ,+periene an& a Fist of Ma+im"m*i6e eent 8ientifi P"liations (Anne*ure 13

i6. (esearch 'roposal: Detaile& Proposal ith ?itle: eti6e(s): 8ope of 0or=: Plan of Ation: Metho&ology Deli6erales. (Anne*ure 2)

6. !onsent Letter !onsent letter from $n&ian instit"tion: if otaine&.

Application -ithout anyone of the aboe enclosures as mentioned at i; to i; aboe -ill be re