How to fill piq form

1. xksiuh;
CONFIDENTIAL
O;fDrxr tkudkjh iz ukoyh
PERSONAL INFORMATION QUESTIONNAIRE
Mh
? vkbZ
?ih
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? iz ukoyh la[;k107-A?la kksf/kr?
DIPRQuestionnaire No. 107-A (Revised)
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[email protected]. .
1 -p;u cksMZ ?la[;k vkSj L;ku?
Selection Board (No. & Place)
cSp la
?
Batch No.
pSLV la
?
Chest No.
;w? ihs? ,l? lh? ;k vU; jksy uEcj
UPSC /Other Roll No.
2 -lqLiI
s
V v{kjks esa uke ?tSlk eSfV?d izek.k&i= esa gS?
Name inCAPITALS(As in the matriculation certificate) __________________________________________________________________
3 -firk dk uke @Father’s Name __________________________________________________________________
4 -(a)vf/kdka k le; vkokl dk LFkku ?LFkku] ftyk] jkT;? ?LFkku dh vuqekfur tula[;k lfgr?
Place ofMaximum Residence (Place, District, State)
(with approximate population of the place) __________________________________________________________________
(b)orZeku vkokl dk LFkku ?LFkku] ftyk] jkT;? ?LFkku dh vuqekfur tula[;k lfgr?
Place ofPresent Residence (Place, District, State)
(with approximate population of the place) __________________________________________________________________
(c)LFkkbZ vkokl dk LFkku ?LFkku] ftyk] jkT;? ?LFkku dh vuqekfur tula[;k lfgr?
Place ofPermanent Residence (Place, District, State)
(with approximate population of the place) __________________________________________________________________
?og ftyk eq[;ky; gS vFok ugh?@(Whether District HQ or not) __________________________________________________________________
5 -fuEu fooj.k Hkjsa @Fill in the details below :-
6 -(a)D;k ekrk&firk ftfor gSa?@Parents Alive gka@ugha @Yes/No
(b);fn ftfor ugha rks ekrk@firk dh e`R;q ds le; vkidh vk;q
If not alive, your age at the time of Mother’s/Father’s death __________________________________________________________________
(c)ekrk&firk@laj{kd vkSj HkkbZ&cgu ds O;olk;@vk; ?tks ykxw gks? @ Parents’/Guardian’s and Siblings’ Occupation/income (as applicable) :-
7 - kSf{kd fjdkMZ ?eSfV?dqys ku@lEd{k ifj{kk ls vkjEHk djds? @ Educational Record (commencing from Matriculation /Equivalent Examination) :-
jkT; vkSj ftyk
State & District
fookfgr@vfookfgr@fo/kqj
Married@Single@Widower
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Religion
vuqlwfpr tkfr@ tutkfr ;fn gS
Whether SC@ST@OBC
ekr` Hkki
s
k
Mother Tongue
tUe frfFk
Date of Birth
fooj.k @Particulars f k{kk@Education O;olk;@Occupation ekfld vk;@Income per month
xksiuh;
CONFIDENTIAL
firk@Father
ekrk@Mother
laj{kd@Guardian
cM+k HkkbZ@cgu@ Elder Brother@ Sister
cM+k HkkbZ@cgu@ Elder Brother@ Sister
NksVk HkkbZ@cgu@ Younger Brother@ Sister
NksVk HkkbZ@cgu@ Younger Brother@ Sister
izkIr ;ksx;rk,sa
Qualification
acquired
laLFkku dk iwjk uke
Full Name of
Institution
cksMZ@;qfuoflZVh
Board@
University
oi
s
Z
Year
Js.kh o vad
izfr kr@Div.
& Marks %
f k{kk dk ek/;e
Medium of
Instruction
Nk=koklh@fnu Nk=
Boarder@Day
Scholar
vlk/kkj.k mIyfC/k] ;fn
dksbZ gks@Outstanding
achievement, if any
eSfV?d@gk;j lSdsaMjh
Matric@Hr. Sec.
10+2ds le{k
10+2 Equivalent
Lukrd@Graduation
LukrdksRrj@O;olkf;d
Post-Graduation@
Professional

2. xksiuh;
CONFIDENTIAL
8 -vk;q ?oi
s
Z vkSj ekg?/Age ( Years & Months) mpkabZ ?ehVjesa?/Height (in Metre) otu ?fdyksxzkeesa?/Weight (in Kilogram)
______________________________________ _____________________________ __________________________________
9 -orZeku O;olk; vkSj O;fDrxr ekfld vk;] ;fn gS
Present Occupation and personal monthly income, if any ______________________________________________________________________________
1 0 -(a) jkI
s
V?h; dSfMV dksj izf k{k.k @N.C.C. Training gka@ugha @Yes/No
(b) ;fn gkWa] rksdqy izf k{k.k ?fooj.k uhps nks? @If Yes, Total Training (Give details below)
1 1 -(a) [ksydwnksa esa Hkkxhnkjh @Participation in games & sports :-
(b) kksd@#fp;ka @ Hobbies / Interest ______________________________________________________________________________
(c) ikB~; foi
s
;srj lkewfgd dk;Zdykiksa esa Hkkxhnkjh@ Participation in extra-curricular, activities :-
(d) jkI
s
V?h; dSMsV dksj@ LdkmfVax@[ksydwn@ ikB~;sRrj vkSj vU; {ks=ksa esa mRrjnkf;Ro dk in
Position of responsiblity/offices held in NCC/Scouting ______________________________________________________________________________
Sports Team/Extra-curricular group and otherfields ______________________________________________________________________________
1 2 -(a) deh ku dk Lo#i @Nature of Commission
(b) lsok dk p;u @Choice of Service
1 3 -rhu lsokvksa esa deh ku ds fy, fdrus ekSds ys pqds gSa &
Number of chances availed for commission in all three Services______________________________________________________________________________
1 4 -fiNys lHkh lk{kkRdkjksa dk fooj.k] ;fn dksbZ gks ?vkehZ @ usoh @ ,;j QkslZ p;u cksMZ?
Details of all previous interviews, if any (Army@Navy@Air Force Selection Boards)
dqy izf k{k.k@Total Training
dze la?
@Sl. No.
ios k dk izdkj ftlds fy, cSBs
Type of Entry
[ksy @dzhM+k dk uke
Games@Sports
dk;Zdyki lewg dk uke
Name of the activity group
Lda/k@Wing izHkkx@Division izkIr izek.k i=@Certificate Obtained
Hkkx ysus dh vof/k@Period or duration
of Participation
Ldwy@dkyst@fo ofo}ky;@vU; tgkWa
dk izfrfuf/kRo fd;k @Represented
School / College / University / Other
vlk/kkj.kfuI
s
ifr] ;fn dksbZ gks
Outstanding achievement, if any
Hkkx ysus dh vof/k@Duration of Participation vlk/kkj.kfuI
s
ifr] ;fn dksbZ gks
Outstanding achievement, if any
xksiuh;
CONFIDENTIAL
,l? ,l? ch? ua?vkSj LFkku
SSB No. & Place
rkjh[k@Date pSLVvkSjcSpua
?
Chest No.@Batch No.