14

ANNEXURE TO APPLICATION FORM

...

PROFORMA TO BE FILLED BY OBC CANDIDATES

1. :
Name of the candidate

2. :
Roll No.

3. ) :
(a)

Name of Father

() :
(b)

Date of birth of Father

4. () :
(a)

Name of Mother

() :
(b)

Date of birth of mother

5. () :
(a)

Profession of father

() (i) , / /

/
(b)

(i) If in service, whether he is/was working under Central

Govt./State Govt./Public Sector Undertaking/Autonomous
Body/Private organisation or somewhere else

(ii) :
Name of the post to which he was appointed by direct recruitment

15

(iii) ( ,, )
:

Group of the post (viz. group A, B, C or D) to which he was

appointed by direct recruitment

(iv) ,,

,

, ,

If posts in the organisation are not classified as Group A, B, C

or D, whether the post to which the father was appointed by
direct recruitment is comparable or equivalent to any group A,
B, C or D post in Govt. If yes, to which it is comparable.

(v) :
Details of all the post held by Father

Name of the post and group of

the post & equivalence of post

Pay Scale of the post

(vi) .,...,

Date of Appointment/
promotion to the post

Age at the time of appointment/

promotion

? , :

Whether the father has/had been in employment in any

International Organisation like U.N., IMF, World Bank. If yes,
duration of such employment.

(vii) ,
If father is dead, date of his demise

16

(viii) ,

If father suffers from permanent imcapacitation, date from which

he so suffers

6. ()

(a) Whether father of the candidate holds or has ever held a Constitutional post

() , () ()
:

(b) If yes, name of the post (s) and duration of holding the post(s)

7.

/,

/ /

If father is/was in armed forces or in para military service, the post which
he is/was holding or held at the time of retirement/leaving the job.

8. ()
(a) Profession of mother

) (i) , / /

If in service, whether she is/was working under Central

Govt./State Govt./Public Sector Undertaking Autonomous
Body/Private organisation or Somewhere else

(ii)
Name of the post to which she was appointed by direct recruitment

(iii) ( ,, )
:

Group of the post (viz. group A, B, C or D) to which she was

appointed by direct recruitment

17
(iv) ,,

,, ,

If posts in the organisation are not classified as Group A, B, C or D,

whether the post to which the mother was appointed by direct
recruitment is comparable or equivalent to any group A, B, C or
D post in Govt. If yes, to which it is comparable.

(v) :
Details of all the posts held by mother :

Pay Scale of the post

Name of the post and group of

the post & equivalence of post

Date of Appointment/
promotion to the post

(vi) ., ...,

? ,
:

Whether the mother has/had been in employment in any

International Organisation like U. N., IMF, World Bank. If yes,
duration of such employment.

(vii) ,
If mother is dead, date of her demise

(viii) ,

If mother suffers from permanent imcapacitation, date from which
she so suffers

/
Age at the time of appointment/
promotion

18

9. ()

(a) Whether mother of the candidate holds or has ever held a
Constitutional post

() , () ()
:
If yes, name of the post (s) and duration of holding the post(s)

10. /,
/ / :
If mother is/was in armed forces or in para military service, the post
which she is/was holding or held at the time of retirement/leaving the job.

11. ()

(A) Whether the parents of the candidate own agricultural land

) ,
(B) If Yes,

() ,

(a) Area of the irrigated land owned by father, mother and

children put together

(),
:
(b) Area of the unirrigated land owned by father, mother and children
put together

()

(c) Statutory ceiling limit of land holding at the place where land
owned is located

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()

...36012/22/93.

(...)

8.9.1993 V ()(i)

(d) If the land is both irrigated and unirrigated, indicate whether
condition given in clause (b) (i) of Schedule V to the DOP&T O.M.
No.36012/22/93-Estt.(CST), dated 8-9-1993 applies. Give details.

12. () :
Annual income of father for last three years (year-wise)

()
(a) Income from salary

()
(b) Income from agriculture

()
(c) Income from other sources

(: )
(Note: Attach income-tax returns)

13. () :
Annual income of mother for last three years (Year-wise)

()
(a) Income from salary

()
(b) Income from agriculture

()
(c) Income from other sources

(: )
(Note : Attach income-tax returns)

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14. ()
(a) Details of wealth held by parents

) ,
?

(b) Whether the wealth held is above in exemption limit as

prescribed in Wealth Tax Act ?

15.

// /

/
?

Whether documentary proof in support of service/status/land

holding/income from different sources/property held by
parents have been attached?

,2013

Information furnished above is true to the best of my knowledge and I have not concealed any relevant information. I swear that if it is found
at any stage that information furnished by me is false or that I have concealed some relevant information, I will forfeit the claim to appointment to any
service on the basis of Civil Services Examination, 2013.

Place :

Date :

MGIPRRND2763 UPSC/10

Signature of the Candidate

2763 UPSC/10