UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM CIVIL SERVICES(MAIN) EXAMINATION , 2012

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 / IndianMission complete address. 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 :2. Name

Candidate Signature |

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 English. in | | | | | | | | | | 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.

Roll No :9. Place of birth : Town/Village District State 10. (a) Community

Candidate Signature

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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

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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 (iii) SECOND OPTIONAL SUBJECT FOR IX . 13. (a) LANGUAGE MEDIUM OF EXAMINATION FOR ESSAY, | GENERAL STUDIES AND FOR OPTIONAL SUBJECTS as at (ii) and (iii) of col. 12 above | PAPERS VI & VII . | PAPERS VIII & |

(b) LANGUAGE MEDIUM FOR INTERVIEW TEST,(c.f. para 27 of the instructions to Candidates). 14. Whether you are a Physically Challenged Candidate. Roll No :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, Candidate Signature | | | | | | | | | | | | | | | | | | 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, 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. Roll No :16.(a)Whether passed Degree or equivalent | | | the |

| Candidate Signature |

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 Ou on eof ofPassi ofSchool/College/Insti ofBoard/Unive Scor rade (s) t Passed Marks(%) ng tution rsity e of

Stream at Graduation Level :--

(c) Do you possess Post Graduation or Higher Qualification

Roll No :17. Were you ever Employed : -

Candidate Signature |

18. Please give particulars of:(a) Particulars of Prizes,Medals, Scholarships etc. (b) Team/Games/Sports/N.C.C. hiking/Mountaineering etc. (c) Position(s) of distinction Leadership held in School/College. (d) Other extra curricular activities and interests.(Such as hobbies etc.) |

/Hitch-|

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 forwhich 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

Roll No :-

Candidate Signature

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 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 Order of Preference

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