PERSONAL INFORMATION QUESTIONNAIRE

1. Selection Board No. _______ City __________ 2. UPSC Roll Number ________________
3. Entry _____ 4. Batch Number____5. Chest Number____ 6. Choice of Service ____

PERSONAL & FAMILY

7. Name (in block capitals) as in the Application Form_________________________

8. Date of birth ____ Day ____Month ____Year 9. Age ___ Years____ Months
10. Gender Male/Female
11. Height ___ cm 12. Weight ___kg. 13. Marital Status Married/Single/Widower
14. Religion Hinduism / Christianity / Islam / Sikhism / Other _________________
15. Mother Tongue _______________________ 16. Community General / OBC /SC/ST.
17. Place of maximum 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(years) Education Occupation Income per

Month
Father
Mother
Guardian
Wife
Brother
Brother
Brother
Sister
Sister
Sister

21. Parents alive? Yes/No ____ If parents not alive, your age at the time of their death ____Years
22. Candidate's present occupation Govt / private / self-employed _____________________
Income per Month ______ Designation /appointment ______Department / firm __________

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 EDUCATIONAL QUALIFICATIONS (COMMEENCING FROM MATRICULATION / EQUIVALENT EXAMINATION)

23. Matric/Higher Secondary

Name of institution (In full, no abberviations) ____________________________________
______________________________________________________________________________________________________

Location of institution (City town village) Name of board

___________________________________ CBSE / ICSE / State Board / Other ____________
Type of institution Govt/private Medium of instruction English / Hindi / Regional ____
Year of passing _____ Overall percentage of marks obtained _____Division______________
Day scholar/boarder

Outstanding
Subject Theroy Practical/Sessionals Total achievements
( if any )
Max Marks % Max Marks % Max Marks %
Marks Obtained Marks Obtaine Marks Obtaine
d d

Total

24. Senior / 10+2/ Equivalent

Name of institution (in full, no abberviations) ________________________________________
_____________________________________________________________________________
Location of institution (City town village) Name of board
_________________________________ CBSE / ICSE / State Board / Other ___________
Type of institution Govt/private Medium of instruction English / Hindi / Regional_________
Year of passing _____ Overall percentage of marks obtained _______ Division ______________
Day scholar/ boarder
Outstanding
Subject Theroy Practical/Sessionals Total achievements
( if any )
Max Marks % Max Marks % Max Marks %
Marks Obtained Marks Obtained Marks Obtained

Total

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25. Graduation
Name of Institution (In full, no abbreviations) ______________________________________________________
____________________________________________________________________________________________
Location of Institution (city/town/village) __________________________________________________________
University ___________________________________________________________________________________
Course BTech/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 percentage_______

Year/ Outstanding
Semester Theroy Practical/Sessionals Total achievements
( if any )
Max Marks % Max Marks % Max Marks %
Marks Obtained Marks Obtained Marks Obtained
1.
2.
3.
4.
5.
6.
7.
8.
8.
Total

26. Post Graduation

Name of Institution (In full, no abbreviations) ________________________________________________________

Location of institution (city/town/ village) ___________________________________________________________
University _____________________________________________________________________________________
Course MTech/M EM. Sc/M.Com/MA. Branch/stream __________________________________________
Year of admission_____ Pursuing/completed ____________ Year of completion ___________ Day scholar/boarder
Medium of Instruction English/Hindi/Regional _______________ Division _______ Aggregate percentage______

Year/ Outstanding
Semester Theroy Practical/Sessionals Total achievements
( if any )
Max Marks % Max Marks % Max Marks %
Marks Obtained Marks Obtained Marks Obtained
1.
2.
3.
4.
Total

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 SPORTS HOBBIES | EXTRA CURRICULAR ACTIVITES | NCC TRAINING AND MISCELLANEOUS
27. Participation in sports
Ser Sports/ Level at which played Level for service candidates Special
No. Period (school / collage / university / (Unit/brigade/division/corps/ achievements
game
district state / national / command/services) ( if any )
played
international
From To

28. Hobbies / interest

Ser Hobby Period Level at which participated Special achievements ( if any )
No.
From To

29. Extra-curricular activities

Ser Extracurricular Period Level at which Special achievements ( if any )
No. participated
activities From To

30. NCC
NCC training Yes/No _____ Total training (in months) _______________ Wing Army / Navy / Air Force
Division Senior / Junior _______________________________________________ Certificate obtained A/B/C
Achievements, if any _________________________________________________________________________
Position of Responsibility /Appointments Held in NCC/Scouting/ Sports /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 Amed forces _________________________________________________________
33. Chances availed for commission in Armed forces :-
Ser SSB Entry Places of SSB Date Batch & Chest No. Recommended(R)
No. Not Recommended (NR)
Screened Out (s/o)
1
2
3
4
5
6
7
8.

9.
10.

Dated : _____________ ( Signature of Candidate)

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