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APPLICATION FOR BEST SCIENTISTS AWARD

|Name |: |Dr/Mr/Ms. |

|Date of Birth & Age |: | |

| | |(Enclose Proof of Age – Birth Certificate or Matriculation Certificate) |

|Nationality |: | |

|Designation |: | |

|Qualification |: | |

|Specialization | | |

|Address |: | |

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|Email address |: | |

|Phone number |: | |

|Total Impact Points obtained |: | |

|(Thomson Reuters) | | |

| | |(Enclose the research publications and its list with latest impact factor (as |

| | |per the annexure -1)) |

|Total Teaching experience in Years | |Attach the list with the proof |

|No. of patents | |Attach the list with the proof |

|No. of conference/ workshop/ seminar | |Attach the list with the proof |

|conducted etc. | | |

|No. of project handled as PI | |Attach the list with the proof |

1. Starting with your present or most recent post, give details of your experience in teaching/research/extension education.

|Designation of the |Period |Name of Institution/ |

|post with scale of pay| |Department |

| |*From |To |Total | |

| | | |(years months & days) | |

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2. Salient contribution made by the candidate in respective field (200 words)

I certify that the information provided above is true and correct to the best of my knowledge. I am agreeable to the terms and conditions of the award. I undertake to abide by the decision of the expert committee, juries and Society of Fisheries and Life Sciences in the matter of the above competition.

Place: ………………………… Signature: …………………..

Date:………………………… Name: ………………………

Endorsement/Recommendation from the Head of the Department/ Institute where the applicant is employed.

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Date: ……………….. ……………………

(Signature of Head of Institution)

Place: ……………….

ANNEXURE -01

PUBLICATIONS

|Sl.No. |Title of the research paper (Full) |Impact factor |Link/URL of the manuscript |

| |Authors name (only first three authors or corresponding author) (Bold the applicant name) |(Thomson Reuters) | |

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|Total points | |

I do hereby declare that information furnished in this Application Form and information furnished above is true to the best of my knowledge and belief. In case if the information is proved to be false, my candidature can be cancelled.

Place:

Date:

Signature of the applicant[pic]

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