Date of Joining the Institute: ………………..……… Fee Paid: YES/ No/ Part Paid ……….……...

PERSONAL INFORMATION QUESTIONNAIRE (PIQ)

1. Selection Board No …. City …………..…………… 2. UPSC Roll Number …
3. Entry ………… 4. Batch Number … 5. Ch No …… 6. Choice of Service … Photograph

Mobile No: +91-………………………..… Email ID: ………..……………………………………

PERSONAL & FAMILY DETAILS

7. Name in block capitals: …………………………………………………………………………………………
8. Date of birth …..…/.……./….…. (dd/mm/yy) 9. Age …….. yrs ……. Months 10. Gender M / F
11. Height ………. cm 12. Wt ………. Kg 13. Marital Status: Married/Single/Widower
14. Religion: Hindu/Christian/Islam/Sikh/Other 15. Mother Tongue ………………………………………
16. Community General/OBC/SC/ST 17. Place of max residence (with state) ……………………..
18. Present Address (including state) with approximate population (in lacs) of city/town/village
………………………………………………………………………………………………………………………..
…………………………………………………………………………………………….....(Population in lacs)

19. Permanent Address (including state)

………………………………………………………………………………………………………………………..
…………………………………………………………………………………………….....(Population in lacs)

20. Particulars of parents/guardian/brothers/sisters:-

Relation Name Age (yrss) Edu Occupation Income (pm)
Father
Mother
Guardian
Wife
Brother
Brother
Sister
Sister

21. Parents alive? Yes / No If parents not alive, your age at the time of their death: ………. yrs.
22. Candidate’s present occupation: Govt/private/Self-employed Income pm Rs …………………..
Designation/appointment: ………………………………….. Depatment/firm: ………………………...
 -2-

EDUCATIONAL QUALIFICATIONS (COMMENCING FROM MATRICULATION/EQUIVALENT EXAMINATION)

23. Matric/Higher Secondary

Name of institution (in full, no abbreviations) ……………………………………………………………….
Location of institution: City/town/village Name of board: CBSE/CSE/State Board/Others
Type of institution: Govt/Private Medium of instruction: English/Hindi/Regional
Year of Passing ……. Overall %age of marks obtained……… Division …….. Day scholar/boarder

Subject Theory Practicals/sessional Total Outstanding

Max Marks % Max Marks % Max Marks % achievement
Marks Obtai Marks Obtai Marks Obtained (if any)
ned ned

Total

24. Senior/Higher Secondary

Name of institution (in full, no abbreviations)

Location of institution (city/town/village) Name of board CBSE/CSE/State Board/Others

Type of institution Govt/Private Medium of instruction English/Hindi/Regional

Year of Passing__________Overall %age obtained________Division________Day scholar/boarder

Subject Theory Practicals/sessionals Total Outstanding

Marks Marks Marks achievemen
Max % Max % Max %
Obtai Obtai Obtained t (if any)
Marks Marks Marks
ned ned

Total

CONFIDENTIAL
 -3-

CONFIDENTIAL
25. Graduation
Name of institution (in full, no abbreviations)

Location of institution (city/town/village) University

Course B Tech/BE/B Sc/ B Com/ BA Branch / Stream

Year of admission__________ Pursuing/completed Year of completion_______ Day

Scholar/Boarder

Medium of instruction English/Hindi/Regional Division ______ Aggregate % age ___________

Year/Semester Theory Practicals/sessionals Total Outstanding

Max Marks % Max Marks % Max Marks % achievement
Marks Obtai Marks Obtained Marks Obtained (if any)
ned
1

Total

26. Post Graduation

Name of institution (in full, no abbreviations)

Location of institution (city/town/village) University

Course B Tech/BE/B Sc/ B Com/ BA Branch / Stream

Year of admission__________ Pursuing/completed Year of completion_______ Day

Scholar/Boarder Medium of instruction Eng/Hindi/Regional Div______ Aggregate %age ________

Year/Semester Theory Practicals/sessionals Total Outstandin

Max Marks % Max Marks % Max Marks % g
Marks Obtai Marks Obtai Mar Obtai achieveme
ned ned ks ned nt (if any)
1

Total

CONFIDENTIAL
 -4-

SPORTS/HOBBIES/EXTRA CURRICULAR ACTIVITIES/NCC TRAINING AND MISCELLANEOUS

27. Participation in sports

Ser No Sport/game Period Level at which Level for service Special

played From To played candidates achievement
(School/college/ (Unit/brigade/division (if any)
university/district/ /corps/command
states/national/ services)
international
1

28. Hobbies / Interests

Ser No Hobby Period Level which Special

From To participated achievement
(if any)
1

29. Extra-Curricular Activities

Ser No Hobby Period Level which Special

From To participated achievement
(if any)
1

30. NCC

NCC training Yes/No Total training (in months) _________________ wing Army/Navy/Air Force
Division Senior/Junior Certificate obtained A/B/C
Position of responsibility/Appointment Held in NCC/Scouting/Sports Teams/Extra Curricular
Group and in any other field.
PREVIOUS ATTENDANCE IN SSB

31. Nature of commission applied for_______________ Choice of Service_____________

32. Number of chances availed for commission in Armed Forces_____________________
33. Chances availed for commission in Armed Forces:-
SNo SSB Entry Place SSB Date Batch & Chest No R/ NR/ SO

Dated: / / (Signature of the Candidate)

 Service Record
(for Service Entry only)

1. No_________________Rank__________Trade________________Name____________________________

2. Unit_______________________Fmn_______________Coprs_____________Comd____________________

3. Date of Enrollment___________________ Total Service ___________years ______months __________

Ser Rank Year of Name of employment in rank Outstanding

No appointment achievement if any

RECORDS OF OPERATIONAL SERVICE

Ser Location of operational Service Period Outstanding

No From To achievement if any

COURSES ATTENDED AT ARMY/NAVY/AIR FORCE

Ser Course attended School of Duration of Result if any

No instruction training

Dated: / / (Signature of the Candidate)