Preview

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

  Application Status
NAME Nitesh Kumar Sharma

REGISTRATION NO 2309NGB0070937

DATE OF BIRTH 11-Nov-2004

APPLIED BRANCH Navik(GD)

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

PAYMENT STATUS Paid

DATE OF APPLICATION FORM 16-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 Nitesh Kumar Sharma FATHER'S NAME Shashikant MOTHER'S NAME Bindu Sharma
Sharma
EMAIL ID XXXXXXXXXXXXXXX MOBILE XXXXXXXXXX ALTERNATE XXXXXXXXXX
MOBILE

NATIONALITY Indian MARITAL Unmarried GENDER Male

STATUS

AADHAR XXXXXXXX6062 ID CARD Aadhaar Card ID CARD NO. XXXXXXXX6062

NUMBER
IDENTIFICATION Mole On Chest IDENTIFICATION Mole On Forehead CATEGORY Other Backward
MARK 1 MARK 2 Class (OBC)
(Non-creamy)
DATE OF ISSUE 18-Aug-2021 DATE OF BIRTH 11-Nov-2004 DATE OF BIRTH 10th Class
OF CATEGORY PROOF TYPE Marksheet/Certi
CERTIFICATE
ficate
SECONDARY XXXXXXXXXXXX AGE RELAXATION No FEE WAVIER No
EMAIL ID XXX CLAIMED

EMPLOYMENT Unemployed COMMUNITY Always valid (no GOT Instagram

TYPE CERTIFICATE validity date INFORMATION
VALIDITY ABOUT INDIAN
mentioned on COAST GUARD
certificate) 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 Central Board of GRADING Percentage DO YOU HAVE No

BOARD Secondary SYSTEM ADDITIONAL
INDICATED IN MARKSHEET
Education MARKSHEET

10TH 0736105 YEAR OF 2020 NO. OF 5

CERTIFICATE PASSING SUBJECTS IN
NUMBER CLASS 10TH

Subject English Mathematics Science Hindi Social Sciences

Marks Obtained 68 72 51 66 63

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 Central Board of GRADING Percentage DO YOU HAVE No

BOARD Secondary SYSTEM ADDITIONAL
INDICATED IN MARKSHEET
Education MARKSHEET

12TH CERTIFICATE 0597124 YEAR OF 2022 NO. OF 6

NUMBER PASSING SUBJECTS IN
CLASS 12TH

Subject Physics Mathematics Chemistry English Physical education Computer science

Marks Obtained 61 47 56 77 75 65

Total Marks 100 100 100 100 100 100

  Additional Details
1) Have you been Discharged from the Indian Army / Indian Navy / Indian Air No
Force or 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 No
by you pending before a criminal court in India ?
4)Has any warrant or summons for your offence been issued and pending before No
a 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 No
a 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 / No
Central or 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/STREET 240 LANDMARK Gayatri mandir, baheri POST OFFICE Kamalpur

COUNTRY India STATE/ UT UTTAR PRADESH DISTRICT Chandauli

SUB DISTRICT Sakaldiha PIN CODE 232106 PHONE NO WITH N.A

AREA CODE

Present/Current Address
HOUSE/STREET 240 LANDMARK Gayatri mandir, baheri POST OFFICE Kamalpur

COUNTRY India STATE/ UT UTTAR PRADESH DISTRICT Chandauli

SUB DISTRICT Sakaldiha PIN CODE 232106 PHONE NO WITH N.A

AREA CODE

Domicile Details
DOMICILE STATE Uttar Pradesh

  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. PRAYAGRAJ 2. VARANASI 3. LUCKNOW 4. KANPUR 5. GORAKHPUR

  Stage - II - Exam City Preferences

1. NOIDA 2. KOLKATA 3. GANDHINAGAR 4. MANGALORE 5. CHENNAI

  List Of Uploaded Documents

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 NO
INCORRECT OR THE DOCUMENTS ARE INCORRECTLY UPLOADED ?

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

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.
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 Verified by (ICG Candidate Signatue Verified by (ICG
Signature for Stage II Officer) at Stage II for Stage III Officer) at 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.
STAGE-I UPLOADED DOCUMENT : ID PROOF (AADHAAR CARD)
STAGE-I UPLOADED DOCUMENT : DATE OF BIRTH PROOF (10TH CLASS
MARKSHEET/CERTIFICATE)
COMMON REASONS FOR REJECTION DURING DOCUMENT VERIFICATION
COMMON REASONS FOR REJECTION DURING DOCUMENT VERIFICATION
COMMON REASONS FOR REJECTION DURING DOCUMENT VERIFICATION

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