Union Public Service Commission

UNION PUBLIC SERVICE COMMISSION
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Roll No :
Name :
1. Details of Fee paid : Fee to be paid is Rs. 200/-(Two hundred only)(Female/SC/ST/Physically

challenged candidates are not required to pay any fee)
Name of Post Office / Value of CRF

IndianMission with Stamps /
complete address. IndianMission
Receipt
Space for affixing Central Recuritment Fee Stamps(This is

the sole mode prescribed for payment of fee)
Total Value :
N.B : Indian Postal Orders/Bank Draft/Money Orders/Crossed Cheque/Treasury Challan/Currency

Notes/Postage/ Revenue/Court Fee Stamps etc. are not acceptable.
Roll No :- Candidate Signature
2. Name |
3. (a) Address for correspondence in |

English to which communication is to
be sent .
Post Office : |
District : |
State : |
Pin Code : |
(b) Telephone No. with STD Code. |
(c) Mobile No. |
(d) Fax No. |
(e) E-mail address. |
(f) Permanent Postal Address in

|
English.
Post Office : |
District : |
State : |
Pin Code : |
4. Gender : |
5. Marital Status : |
6. Citizenship : |
7. Your mother tongue |
8. (a) Date of Birth |

(b) Claimed Age relaxation. |
9. Place of birth :
Town/Village |
District |
State |
10. (a) Community |
Note 1 : No Change in the community status already indicated by a candidate in his/her application
form for this examination will ordinarily be allowed by the Commission.
Note 2 : In case you are a 'SC,ST or OBC' candidate, enclose a copy of certificate in support of your
claim
(b) Your minority community , if any |
11. Choice of centre for examination |
12. (i)(a) Do you hail from Arunchal |

Pradesh/Manipur/ Meghalaya/Mizoram/Nagaland/Sikkim
and are claming exemption from appearing
in Indian Language For Paper I ?
(b) INDIAN LANGUAGE FOR PAPER I . |
(ii) FIRST OPTIONAL SUBJECT FOR PAPERS VI & VII . |
13. (a) LANGUAGE MEDIUM OF EXAMINATION FOR ESSAY, |

GENERAL STUDIES AND FOR OPTIONAL SUBJECTS as at (ii) and
(iii) of col. 12 above
(b) LANGUAGE MEDIUM FOR INTERVIEW |
TEST,(c.f. para 27 of the instructions to Candidates).
14. Whether you are a Physically |
Challenged Candidate.
15. (a) Name of Father |
(b) Name of Mother |
(c) Nationality of Father |
(d) Nationality of Mother |
(e) Father's present postal Address |
(If deceased give last address) |
Post Office: |
District/City : |
State : |
Pin code : |
(f) Mother's present postal Address |
(If deceased give last address) |
Post Office: |
District/City : |
State : |
Pin code : |
(g) Father's Profession : |
(h) Mother's Profession : |
(i) If your Father is in service, the |

post held by him(If retired,
the post held by him at the
time of his retirement).
(j) If your Mother is in service, the

|
post held by her(If retired,
the post held by her at the
time of her retirement).
(k) Annual income of your Father |
(l) Annual income of your Mother |
(m) District to which your

|
Father originally belongs.
(n) State to which your

|
Father originally belongs.
(o) District to which your

|
Mother originally belongs.
(p) State to which your

|
Mother originally belongs.
16.(a)Whether passed Degree or |

equivalent
Examination. (Enclose copy of the Certificate )
(b) Educational Qualifications : Commencing with Matriculation or equivalent examination till

Graduation :-
CGPA
Examinati Percentag Year Name Name
Class/Division/G Subject
on eof Ou ofPassi ofSchool/College/Insti ofBoard/Unive
rade Scor (s)
Passed Marks(%) t ng tution rsity
e
of
Stream at Graduation Level :--
(c) Do you possess Post Graduation or |

Higher
Qualification
17. Were you ever Employed : - |
18. Please give particulars of:-
(a) Particulars of Prizes,Medals, |

Scholarships etc.
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(d) Other extra curricular activities and |

interests.(Such as hobbies etc.)
Roll No : Candidate Signature
19. Having regard to answers given against |

Columns 7,9,15,16(b) & 16(c) which is
the State/Union Territory that you
would claim as your home State/U.T.
20. In case you are considered for appointment to IAS/IPS, your order of preference for various
State cadres for which you would like to be considered .
State Cadres Indicate Your order of Preference
IAS IPS
Andhra Pradesh
AGMUT
Assam,Meghalaya
Bihar
Chhattisgarh
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Manipur Tripura
Nagaland
Orissa
Punjab
Rajasthan
Sikkim
Tamil Nadu
Uttarakhand
Uttar Pradesh
West Bengal
Note: It is clarified that as per the present scheme of things as envisaged by the Cadre
Allocation Policy,2008,amended from time to time ,if a candidate appointed the All India
Services does not express his/her first preferences to his/her home cadre,he/she shall not be
considered for his/her home cadre at all. The Candudates are therefore advised to excerise
due discretion.while filling up the above preferences.
21. Your order of preference against the Services/Posts given below,for which you wolud like to be
considered for appointment.
Name of Services/Post Order of Preference
Indian Administrative Service
Indian Foreign Service
Indian Police Service
Indian P&T Accounts & Finance Service Group "A"
Indian Audit & Accounts Service, Group "A"
Indian Revenue Service,(Customs and Central Excise)Group "A"
Indian Defence Accounts Service ,Group "A"
Indian Revenue Service, (I.T.) Group "A"
Indian Ordance Factories Service,Group "A" (Asstt. Works

Manager,Administration)
Indian Postal Service,Group "A"
Indian Civil Accounts Service ,Group "A"
Indian Railway Traffic Service,Group "A"
Indian Railway Accounts Service ,Group "A"
Indian Railway Personnel Service,Group "A"
Post Of Asstt. Security Commissioner,group "A" in Railway Protection

Force
Indian Defence Estates Service ,Group "A"
Indian Information Service ,(Junior Grade) Group "A"
Indian Trade Service,Group "A" (Grade III)
Indian Corporate Law Service ,Group "A"
Armed Forces Headquarters ,Civil Service ,Group 'B'(Section

Officers'Grade)
The Delhi ,andaman and Nicobar Islan

Union Public Service Commission

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UNION PUBLIC SERVICE COMMISSION

!"#$%&"! $''&%($#%)* +),- (%.%& /",.%("/0-$%*1 "2$-%*$#%)*, 2018

1. Details of Fee paid : Fee to be paid is Rs. 200/-(Two hundred only)(Female/SC/ST/Physically

Name of Post Office / Value of CRF

Space for affixing Central Recuritment Fee Stamps(This is

N.B : Indian Postal Orders/Bank Draft/Money Orders/Crossed Cheque/Treasury Challan/Currency

3. (a) Address for correspondence in |

(b) Telephone No. with STD Code. |

(c) Mobile No. |

(d) Fax No. |

(e) E-mail address. |

(f) Permanent Postal Address in

7. Your mother tongue |

8. (a) Date of Birth |

Roll No :- Candidate Signature

10. (a) Community |

form for this examination will ordinarily be allowed by the Commission.

(b) Your minority community , if any |

11. Choice of centre for examination |

12. (i)(a) Do you hail from Arunchal |

(b) INDIAN LANGUAGE FOR PAPER I . |

(ii) FIRST OPTIONAL SUBJECT FOR PAPERS VI & VII . |

13. (a) LANGUAGE MEDIUM OF EXAMINATION FOR ESSAY, |

TEST,(c.f. para 27 of the instructions to Candidates).

14. Whether you are a Physically |

Roll No :- Candidate Signature

15. (a) Name of Father |

(b) Name of Mother |

(c) Nationality of Father |

(d) Nationality of Mother |

(e) Father's present postal Address |

(If deceased give last address) |

(f) Mother's present postal Address |

(If deceased give last address) |

(g) Father's Profession : |

(h) Mother's Profession : |

(i) If your Father is in service, the |

the post held by him at the

time of his retirement).

(j) If your Mother is in service, the

the post held by her at the

time of her retirement).

(k) Annual income of your Father |

(l) Annual income of your Mother |

(m) District to which your

(n) State to which your

(o) District to which your

(p) State to which your

Roll No :- Candidate Signature

16.(a)Whether passed Degree or |

Examination. (Enclose copy of the Certificate )

(b) Educational Qualifications : Commencing with Matriculation or equivalent examination till

(c) Do you possess Post Graduation or |

Roll No :- Candidate Signature

17. Were you ever Employed : - |

18. Please give particulars of:-

(a) Particulars of Prizes,Medals, |

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