PIQ Form

1. No. of Brother and Sisters..............................................

2. Your Ranking among Brothers and Sisters.......................
3. Education and Occupation of Siblings..............................

QIR...........

1. Selection Board
(No. & Place)

UPSC Roll No.

Batch No.

Chest No.

2. Name in CAPITALS (As in the application form)

..................................................
3. Father's Name
..................................................
4.
4a. Place of Maximum residence
...................................................
4b. Present Address (With Approximate population of city/village/town) ................................
4c. Permanent Address (With Approximate population of city/village/town)...........................
Whether District HQ or not
.................................................
5. Fill in the details below:-

State &
District

Religion

Whether
SC/ST

Mother
Tongue

Date of
Birth

Married/Single/Widower

6.
6. (a) Parents alive
Yes/No.....................
6. (b) If not alive, your age at the time of father/mother's death.......................................
6. (c) Parents/Guardians Occupation/income (as applicable).............................................

Particulars

Education

Occupation

Income per Month

Father
Mother
Guardians
7. Educational Record (commencing form Matriculation/Equivalent Examination):-

SI.No

Metric/Hr.Sec.
10+2 Equivalent
B.A./B.Sc./B.Com.
Professional

Qualification
acquired

Name of
Institution

Division
Year & Marks
%

Medium of
Instruction

Border/Day
Scholar

Outstanding
achievement, if
any

8. Age (Year & Month)

Height (In Meters)

Weight (In Kilograms)

....................................................................................................................................
9. Present Occupation and Present Monthly income, if any..................................................
10.
10. (a) N.C.C Training
10. (b) Total Trg. (Give details below)
Total Training

Yes/No

Wing

Division

Certificate Obtained

11.
11.(a) Participation in Games and Sports :-

Period of Duration of
Games/Sports
Participation

Outstanding
Achievement
if any

Represented
School/College/University

........................................................................

11. (b) Hobbies/Interests

11. (c) Participation in Extra-curricular, activities:Name of the Activity Group

Duration of Participation

Outstanding Achievement, if any

11. (d) Position of responsibility/offices held in NCC/Scouting/

Sports Team/Extra-curricular Group and other field :12.
12. (a) Nature of Commission
12. (b) Choice of Service

..................................................
..................................................

13. Number of Chances availed for commission in all three services ................................
14. Details of last Interview, If any (Air/Army/Navy Selection Boards)............................

SI. No

Type of Entry

Place and SSB No.

Dated: ______________________

Date

Batch and Chest No.

Recommended/
Not Recommended

(Signature of candidate)

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