Indian Coast Guard Application for Enrolled Personnel CGEPT-01/2024

  Application Status
NAME Jitu Kumar

REGISTRATION NO 2309NGB0049613

DATE OF BIRTH 02-Apr-2002

APPLIED BRANCH Navik(GD)

CATEGORY Other Backward Class (OBC) (Non-creamy)

PAYMENT STATUS Paid

DATE OF APPLICATION FORM 14-Sep-2023

SUBMITTED

  Personal Information
Note/Instructions:
1. Please do not use any prefix such as Mr or Ms.
2. Name as recorded in the matriculation/secondary examination marksheet.
3. Name (Candidate’s/Father’s/Mother’s Name) given in the application and all the uploaded documents i.e. ID Card, educational
certificates, category certificate (SC/ST/OBC/EWS) or any other uploaded document should be same or else the candidature will be
cancelled.
4. E-mail ID and mobile number once entered can’t be changed during the entire recruitment process.
5. Candidate is to bring same ID card (provided here) in original at all stages of recruitment.
6. Two different identification marks such as birthmark, mole and burn/injury mark are to be entered as text.
7. Candidate to upload class 10th marksheet with date of birth mentioned on certificate as date of birth proof or else Birth certificate to
be uploaded.
8. Candidate is to scan the original documents (neither photocopy nor self-attested photocopy) to upload in the online application.
9. Scanned document should be saved in .jpeg / .jpg format and size should be between 50KB to 150KB.
10. All the uploaded documents uploaded must be in Hindi or English. If, the document is in any language other than English or Hindi
then candidate is to upload both original and English translation of document as one file/document (after merging both documents)
in the online application.
11. Click here for specimen of document.
12. Candidates belonging to OBC but coming in the ‘Creamy layer’ are to apply as unreserved candidate.
13. OBC certificate shall be as per Govt. of India format (No other format will be entertained).
14. OBC candidate availing their respective quota, must ensure that valid category certificate should have been issued (date of issue) on
or before the closing date of application.
15. Validity of OBC certificate has to be atleast upto 31 Aug 2024.

NAME Jitu Kumar FATHER'S NAME Ram Avatar Thakur MOTHER'S NAME Rita Devi

EMAIL ID XXXXXXXXXXXXXXX MOBILE XXXXXXXXXX NATIONALITY Indian

MARITAL STATUS Unmarried GENDER Male AADHAR NUMBER XXXXXXXX1932

ID CARD Aadhaar Card ID CARD NO. XXXXXXXX1932 IDENTIFICATION A Mole On The Right Chest
MARK 1

IDENTIFICATION A Cut Mark In Right Head CATEGORY Other Backward DATE OF ISSUE OF 03-Dec-2022
MARK 2 Class (OBC) (Non- CATEGORY
CERTIFICATE
creamy)
DATE OF BIRTH 02-Apr-2002 DATE OF BIRTH 10th Class AGE RELAXATION Yes
PROOF TYPE Marksheet/Certific
ate
FEE WAVIER No EMPLOYMENT Unemployed COMMUNITY Always valid (no
CLAIMED TYPE CERTIFICATE validity date
VALIDITY
mentioned on
certificate)

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 GOT INFORMATION Friends/ Relatives
ABOUT INDIAN
COAST GUARD
RECRUITMENT

  Class 10th Details

Note/Instructions:
1. 10th marksheet and certificate need to be uploaded at Stage-II.
2. In case of CGPA or Grade, conversion formula document need to be uploaded at Stage-II.
3. If you have additional certificate, the document of the same need to be uploaded at Stage-II.

EDUCATION BOARD Bihar School GRADING SYSTEM Percentage DO YOU HAVE No

Examination Board INDICATED IN ADDITIONAL
MARKSHEET MARKSHEET

10TH CERTIFICATE 730000508 YEAR OF PASSING 2019 NO. OF SUBJECTS 5

NUMBER IN CLASS 10TH

Subject Hindi Sanskrit Mathematics Science Social Sciences

Marks Obtained 72 69 42 62 68

Total Marks 100 100 100 100 100

  Class 12th Details

Note/Instructions:
1. 12th marksheet and certificate need to be uploaded at Stage-II.
2. In case of CGPA or Grade, conversion formula document need to be uploaded at Stage-II.
3. If you have additional certificate, the document of the same need to be uploaded at Stage-II.

EDUCATION BOARD Bihar School GRADING SYSTEM Percentage DO YOU HAVE Yes
Examination Board INDICATED IN ADDITIONAL
MARKSHEET MARKSHEET

12TH CERTIFICATE 1211315254 YEAR OF PASSING 2021 NO. OF SUBJECTS 6

NUMBER IN CLASS 12TH

Subject Physics Mathematics Hindi English Chemistry Biology

Marks Obtained 58 65 56 65 51 71

Total Marks 100 100 100 100 100 100

  Additional Details
1) Have you been Discharged from the Indian Army / Indian Navy / Indian Air Force or any No
government organization ?
2) Has any warrant or summons for your appearance as witness been issued and pending No
before a court of law for the time being in force ?
3) Are any proceedings in respect of an offence alleged to have been committed by you No
pending before a criminal court in India ?
4)Has any warrant or summons for your offence been issued and pending before a court of No
law for the time being in force ?
5) Has a warrant for your arrest been issued by a court under any law for the time being in No
force ?
6) Have you, at any time preceding the date of this application, been convicted by a court of No
India for any offence and sentenced in respect thereof to imprisonment ?
7) Have you applied in higher court for acquittal against the conviction of lower court ? No

8) Have you ever been debarred by ICG / Army / Navy / Air Force / UPSC / Central or State No
govt. during any recruitment process ?

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   Communication Details

Note/Instructions:
1. In case of reserved category applicants, either current or permanent address of online application should be same as the address
mentioned in caste/category certificate (SC, ST, OBC(Non-Creamy Layer) & EWS).

Permanent Address
HOUSE/STREET AT-ANAITH ARA, PO- LANDMARK NEAR G.S. MEMORIAL POST OFFICE ANAITH
ANAITH, PS-NAWADA, SCHOOL KHARAHA
DIST-BHOJPUR, BIHAR, KUNWA ANAITH ARA
802302
COUNTRY India STATE/ UT BIHAR DISTRICT Bhojpur

SUB DISTRICT Arrah PIN CODE 802302 PHONE NO WITH N.A

AREA CODE

Present/Current Address
HOUSE/STREET AT-ANAITH ARA, PO- LANDMARK NEAR G.S. MEMORIAL POST OFFICE ANAITH
ANAITH, PS-NAWADA, SCHOOL KHARAHA
DIST-BHOJPUR, BIHAR, KUNWA ANAITH ARA
802302
COUNTRY India STATE/ UT BIHAR DISTRICT Bhojpur

SUB DISTRICT Arrah PIN CODE 802302 PHONE NO WITH N.A

AREA CODE

Domicile Details
DOMICILE STATE Bihar

  Photo And Signature

Note/Instructions:
1. Click here for specimen of photograph.
2. While uploading Photo / Signature / Thumb image, file nomenclature should be as follows:
Passport photograph: Passport_Photograph
Scanned signature image: Signature
Left hand thumb impression image: Thumb_Impression
3. Any discrepancy or anomaly in clarity of images of uploaded documents in the online application will lead to cancellation of
candidature.

PHOTO LEFT HAND THUMB IMPRESSION SIGNATURE

  Stage - I - Exam City Preferences

Note/Instructions:
1. Candidates are to fill first choice within 30 kms from the present residence. In case if no centre is available within 30 kms then the
other choices should be nearest to the present address.
2. Your next 4 preferences nearest to present address in increasing order of distance.
3. Non-compliance to these instructions may lead to cancellation of your candidature during document verification.

1. PATNA 2. GAYA 3. VARANASI 4. BHAGALPUR 5. MUZAFFARPUR

  Stage - II - Exam City Preferences

1. KOLKATA 2. BHUBANESHWAR 3. NOIDA 4. VISAKHAPATANAM 5. GOA

  List Of Uploaded Documents

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 Note/Instructions:
1. Uploading of documents/additional documents is restricted upto prior downloading of E-admit card for Stage-II. No documents can
be uploaded by the candidate after downloading Stage-II E-admit card. Failure of uploading of documents within the time
promulgated by ICG will lead to the cancellation of candidature. Any request for uploading new document after downloading of E-
admit card for Stage-II will not be entertained.
2. Affidavits duly signed by the candidate accepting their mistake of false information in online application will not be considered at
various stages of examination and their candidature will be cancelled.
3. Documents in Digilocker will not be accepted at any stage of the examination as electronic devices are not permitted in examination
premises. Candidates to bring their original documents at all stages of CGEPT examination.
4. All candidates will be compulsorily subjected to identity check prior commencement of the examination of Stage- I, II, III of CGEPT.
The identity check will include verification/matching of Photograph, biometric, signature and identification marks as mentioned in
this application.

Stage-I
1. ID Proof (Aadhaar Card)
2. Date of Birth Proof (10th Class Marksheet/Certificate)

Checking for Print Preview

Note/Instructions:
You are directed to completely check the print preview of the application and certify that your application is correct in all aspects as per
the advertisement. You are directed to go through the common reasons for rejection as published on the website and certify that your
application is correct and does not fall for rejection in document verification as per the rules prescribed in the advertisement for Stage-
I, II & III as published on the website. You may edit the application and the uploaded documents if there is any mistake or error before
submitting the application. Once the application is submitted, no changes are allowed.
a. HAVE YOU SEEN THE PRINT PREVIEW BEFORE SUBMITTING THE APPLICATION ? YES

b. DO YOU WANT TO EDIT THE APPLICATION OR THE UPLOADED DOCUMENTS IF THE DETAILS IN YOUR APPLICATION ARE INCORRECT OR THE YES
DOCUMENTS ARE INCORRECTLY UPLOADED ?

c. DID YOU UTILIZE THE "EDIT" OPTION AFTER SEEING THE PRINT PREVIEW PRIOR FINAL SUBMISSION ? YES

d. DO YOU WANT TO SUBMIT THE APPLICATION FINALLY ? YES

IF YOU CHECK YES, YOU WILL BE DIRECTED TO PAYMENT PAGE AND YOUR APPLICATION WILL BE SUBMITTED AND NO CHANGES WILL BE
ALLOWED FURTHER.

  Declaration
a. I hereby declare that all the above information provided by me is correct.
b. I owe allegiance to the sovereignty, unity and integrity of India. I have not lost, surrendered or been deprived of the citizenship of India.
c. I am eligible to apply for the said rank category as per the Indian Coast Guard (ICG) advertisement for present batch and have also
read the FAQs and common reasons for rejection during various stages of recruitment given on website.
d. I declare that I have applied for only one post viz. either Navik (DB) or Navik (GD) or Yantrik (Mechanical) or Yantrik (Electrical) or Yantrik
(Electronics) in present cycle. I understand that if, multiple applications are filled by me, then ,only the latest filled application will be
accepted and all the other applications will be rejected and the exam fee paid against these applications will not be refunded.
e. I declare to remember my mobile number and E-mail ID used during filling of online application, as, the primary mode of
communication of ICG with me will be either through ICG website or E-mail.
f. I understand that Coast Guard will be uploading E-admit card, result of various stages of recruitment in my login dashboard and will
also be publishing various updates/announcements regarding recruitment on Coast Guard recruitment website. Hence, I declare to
visit ICG website and my login dashboard on regular/daily basis. ICG will not be responsible if I fail to visit ICG website on a daily basis
and comply with the instructions therein given from time to time and will not claim re-examination.
g. I understand that capturing and verification of biometric impression is mandatory for appearing at all stages of recruitment.
h. I understand that Indian Coast Guard reserves the right to conduct assessment/adaptability of candidates at any stage of the
recruitment process, prior issue of appointment letter to avoid impersonation. I understand that my candidature can be cancelled on
account of impersonation and the decision of Indian Coast Guard will be final and binding on me in this regard.
i. I understand that my candidature will be cancelled and I will be debarred from future Coast Guard Recruitment examinations in case I
am found to be involved in malpractice during any stage of current recruitment process.

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 j. I affirm that the information and particulars given by me in this application are true/correct and I am not suppressing any material
information in this regard. I further affirm that the certificates (ID Proof/DOB proof/NOC/Domicile certificate) uploaded in support of
my application for recruitment of the said post are authentic and solely pertain to me and I am fully responsible for the accuracy of
the same.
k. I declare that my SC/ST/OBC (non-creamy layer)/EWS certificate comply with the instructions given in the advertisement regarding
the format of certificate for appointment to the post under Government of India. If my candidature is cancelled on account of
incorrect category document then I shall not be considered against unreserved vacancy as I have submitted false information.
l. I certify that I am in possession of originals of all the documents uploaded in the online application. Failure to present the original
document as uploaded in online application on account of loss of documents will lead to cancellation of candidature. I understand
that no request in this regard will be entertained by ICG even if I produce an F.I.R. w.r.t. theft of my documents and my candidature will
stand cancelled.
m. I declare that the form is filled by myself and not any other person, and for any mismatch/wrong information/incorrect
photo/signature/thumb image uploads, I will be responsible. I am aware that, my candidature can be cancelled, in case of any
mismatch/wrong information.
n. I have completely checked the print preview of the application and I certify that my application is correct in all aspects as per the
advertisement.
o. NO CLAIM / RISK UNDERTAKING:- I am a candidate for recruitment in Indian Coast Guard. I give my full and free consent at my own
risk that I shall not be entitled to claim any compensation or other relief from the government in respect of any injury or disability
which I may sustain in the course of or as the result of any of the tests (both physical fitness test and medical test) administrated to
me or attended by me during the recruitment procedure, whether due to my own negligence or any other person or otherwise.

Candidate Upload Candidate Signatue for Verified by (ICG Officer) Candidate Signatue for Verified by (ICG Officer) at
Signature Stage II at Stage II Stage III Stage III

STAMP STAMP

Name: Name:

Rank: Rank:

Note:- Candidate will have to bring the same application form which is verified at Stage II by ICG while reporting at INS Chilka Stage III
or else the candidature will be cancelled.

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 STAGE-I UPLOADED DOCUMENT : ID PROOF (AADHAAR CARD)

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 STAGE-I UPLOADED DOCUMENT : DATE OF BIRTH PROOF (10TH CLASS
MARKSHEET/CERTIFICATE)

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 COMMON REASONS FOR REJECTION DURING DOCUMENT VERIFICATION

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 COMMON REASONS FOR REJECTION DURING DOCUMENT VERIFICATION

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 COMMON REASONS FOR REJECTION DURING DOCUMENT VERIFICATION

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