Annexure IX
APPLICATION FOR PUBLICATION SUBSIDY GRANT
Address your application to :
Member Secretary ICHR
35 Ferozeshah Road
New Delhi – 110001
PERSONAL DETAILS
1.Name (as per SSCCertificate)
2.Gender Male Female Third Gender
3.Date ofBirth- [DD/MM/YYYY]
(as recorded in SSC or equivalentCertificate)
4.Name ofMother
5.Name ofFather
6.Nationaliity
7.Address for Communication (HouseNo) Street/Locality
City District
State Pin Code
8.PermanentAddress(H.No.)
Street/Locality
City District
State Pin Code
9.Zone : North South East West North East
10.Rural Urban
Class of City: X Y Z
11.Email ID @
12.ContactNo: Landline Mobile
13.Category: General SC ST OBC Minorities PWD
(Pleaseattach self-attested copy oftheCategory/Caste/Tribe certificates from appropriate authority)
ACADEMIC DETAILS
1.Topic of the thesis/manuscript/proceedings:-
2.In case of doctoral thesis:-
(a)The year in which the degree was awarded:-
(b)The name of the University and the Department:-
(c)Number of words/pages of the typescript:-
(d)Name of examiners if, Know:-
(e)State clearly whether your College/University/Institution is recognized by University Grants Commission, New Delhi: - Yes/No
3.Present state of the applicant (If employed with designation and address of the employer)
4.Note: Before submitting this application, the thesis should be revised, if the examiners have suggested revision.
5.Details of the financial assistance received from the ICHR, if any, for the preparation of the thesis/manuscript.
6.Budget Estimate for Publication:-
7.Checklist of enclosures needed
(i)Copy of SC/ST/ disability certificate, if applicable.
(ii)Copy of manuscript/thesis/proceedings (this will be returned to the scholar)
(iii)Copy of reports of examiners.
(iv)Copies of published paper, if any
N.B. Doctoral dissertation should not be more than two years old.
Place:Signature of the Applicant
Date:
Declaration
I have read the Revised Research Funding Rules,September 2015 and agree to abide by them.
Signature of Applicant