Details for Empanelment as an Expert in ASRB

1	Name	*
2	Date of Birth	*
3	Category	*
4	Residential Address	*
5	Mobile Number	*
6	Email Id	*
7	Present Designation/ Last Designation if retired	*
8	Detail of Present Employer/ Last Employer if retired	*
9	Present Pay Scale not below the Level-14 if in Service or Last Pay Scale not below the Level-14 if retired	*
10	Official Address if in service or If retired, Name and address of the organization last served	*
11	Name of Discipline in Ph.D Degree	*
12	Broad area of expertise	*
13	Specialized area of expertise	*
I hereby certify that no vigilance / disciplinary proceedings are pending against me or no penalties under CCS (Conduct) Rules were imposed during my service and all information mentioned above is true to the best of my knowledge and belief.