PIQ Form

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

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

1. Selection Board
Batch No. Chest No. UPSC Roll No.
(No. & Place)

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 & Whether Mother Date of

Religion Married/Single/Widower
District SC/ST Tongue Birth

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):-

Division Outstanding
Qualification Name of Medium of Border/Day
SI.No Year & Marks achievement, if
acquired Institution Instruction Scholar
% any

Metric/Hr.Sec.
10+2 Equivalent
B.A./B.Sc./B.Com.
Professional
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 Yes/No
10. (b) Total Trg. (Give details below)

Total Training Wing Division Certificate Obtained

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

Outstanding
Period of Duration of Represented
Games/Sports Achievement
Participation School/College/University
if any

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)............................

Recommended/
SI. No Type of Entry Place and SSB No. Date Batch and Chest No.
Not Recommended

Dated: ______________________ (Signature of candidate)

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