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  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. SC 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.

NAME Sonu Kumar FATHER'S Surya Deo MOTHER'S Babita Paswan

NAME NAME
Paswan
EMAIL ID sdpaswan66@gmail.c MOBILE 919905755400 ALTERNATE 919534047642
om MOBILE

NATIONALI Indian MARITAL Unmarried GENDER Male

TY STATUS

AADHAR XXXXXXXX9839 ID CARD PAN Card ID CARD XXXXXX828H

NUMBER
NUMBER

IDENTIFICA Cut Mark On Left Side IDENTIFICA A Mole Mark On Right CATEGORY Scheduled
TION MARK TION MARK
1
Eye Borrow 2
Hand Caste (SC)

DATE OF 24-Nov-2020 DATE OF 19-May-2003 DATE OF 10th Class

ISSUE OF BIRTH BIRTH
CATEGORY PROOF
Marksheet/Cer
CERTIFICAT TYPE tificate
E

SECONDAR premkr9991@g AGE No FEE Yes

Y EMAIL ID RELAXATIO WAVIER
mail.com N CLAIMED

EMPLOYME Private Sector ORGANIZA LIC EXPERIENC 15

NT TYPE TION E IN
Employed MONTHS

COMMUNIT Always valid GOT https://www.sarkarire

Y INFORMATI
CERTIFICAT
(no validity date ON ABOUT
sult.com/
E VALIDITY mentioned on INDIAN
certificate) COAST
GUARD
RECRUITME
NT

ID Proof (PAN Card) Date of Birth Proof (10th Class

Marksheet/Certificate)

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  Post Selection

POST Navik(GD)
APPLIE
D

  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.

EDUCATIO Central Board GRADING Percentage DO YOU Yes

N BOARD SYSTEM AS HAVE
of Secondary INDICATED ADDITIONA
Education IN L
MARKSHEE MARKSHEE
T T

10TH 0646981 YEAR OF 2019 NO. OF 5

CERTIFICAT PASSING SUBJECTS
E NUMBER IN CLASS
10TH

Subject Mathematics Hindi Science Social Sciences English

Marks Obtained 38 72 33 46 51

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.

EDUCATIO Jharkhand GRADING Percentage DO YOU Yes

N BOARD SYSTEM HAVE
Academic INDICATED ADDITIONA
Council, Ranchi IN L
MARKSHEE MARKSHEE
T T

12TH 126773 YEAR OF 2021 NO. OF 5

CERTIFICAT PASSING SUBJECTS
E NUMBER IN CLASS
12TH

Subject Physics Mathematics Chemistry English Economics

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Marks Obtained 54 37 64 55 54

Total Marks 100 100 100 100 100

  Additional Details

1) HAVE YOU BEEN DISCHARGED FROM THE INDIAN ARMY / INDIAN NAVY / INDIAN AIR FORCE OR No
ANY GOVERNMENT ORGANIZATION ?
2) HAS ANY WARRANT OR SUMMONS FOR YOUR APPEARANCE AS WITNESS BEEN ISSUED AND No
PENDING 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 No
YOU PENDING BEFORE A CRIMINAL COURT IN INDIA ?
4) HAS ANY WARRANT OR SUMMONS FOR YOUR OFFENCE BEEN ISSUED AND PENDING BEFORE A No
COURT OF 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 No
BEING IN FORCE ?
6) HAVE YOU, AT ANY TIME PRECEDING THE DATE OF THIS APPLICATION, BEEN CONVICTED BY A No
COURT OF 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 No
COURT ?
8) HAVE YOU EVER BEEN DEBARRED BY ICG / ARMY / NAVY / AIR FORCE / UPSC / CENTRAL OR No
STATE GOVT. DURING ANY RECRUITMENT PROCESS ?

  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/ST Golden pahari khas LANDMARK Kali Mandir POST Khasjeena Gora
REET OFFICE
jeena gora
COUNTRY India STATE/ UT JHARKHAND DISTRICT Dhanbad
SUB Dhanbad-Cum- PIN CODE 828115 PHONE NO 9905755400
DISTRICT WITH AREA
Kenduadih-Cum-
Jagata CODE

Present/Current Address
HOUSE/ST Golden pahari khas LANDMARK Kali Mandir POST Khasjeena Gora
REET OFFICE
jeena gora
COUNTRY India STATE/ UT JHARKHAND DISTRICT Dhanbad
SUB Dhanbad-Cum- PIN CODE 828115 PHONE NO 9905755400
DISTRICT WITH AREA
Kenduadih-Cum- CODE
Jagata
Domicile Details
DOMICILE Jharkhand
STATE

  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:

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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 IMAGE 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. Dhanbad 2. Jamshedpur 3. Ranchi 4. Gaya 5. Chapra

  Stage - II - Exam City Preferences

1. Kolkata 2. 3. Noida 4. Chennai 5.

Bhubaneshwar Visakhapatana
m

  Uploaded Documents

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ID PROOF (PAN CARD)

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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

 Declaration

CIT Dhanbad DA 23-09-2023

Y * TE

I hereby declare that all the above information provided by me is correct.

I owe allegiance to the sovereignty, unity and integrity of India. I have not lost, surrendered or been
deprived of the citizenship of India.
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.
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.

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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.
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.
I understand that capturing and verification of biometric impression is mandatory for appearing at all
stages of recruitment.
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 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.
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.
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.
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.
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.
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.
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.

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 Checking for print preview

Note/Instructions:
1. 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.
HAVE YOU SEEN THE PRINT PREVIEW BEFORE SUBMITTING THE APPLICATION ? YES NO

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DO YOU WANT TO EDIT THE APPLICATION OR THE UPLOADED DOCUMENTS IF THE DETAILS IN YOUR
YES NO
APPLICATION ARE INCORRECT OR THE DOCUMENTS ARE INCORRECTLY UPLOADED ?

DID YOU UTILIZE THE "EDIT" OPTION AFTER SEEING THE PRINT PREVIEW PRIOR FINAL SUBMISSION ? YES NO

DO YOU WANT TO SUBMIT THE APPLICATION FINALLY ?

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

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