Page No.

1/9

UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM
CIVIL SERVICES(MAIN) EXAMINATION, 2013

Paste here identical

photograph as per
instruction of para 33.

Roll No. : 497585

Name : ANURAG CHAND

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 Stamps
Indian
/ Indian
Mission with complete
Mission Receipt
address.

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. :- 497585

| Candidate Signature :

Page No. 2/9

2. Name

| ANURAG CHAND

3. (a) Address for correspondence 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

B-706 ENGINEERS PARK

OMEGA-1
GREATER NOIDA
GAUTAMBUDHA NAGAR
UTTAR PRADESH
201308
| 0120-2340184
| 8800506806
|
|
|
|
|
|
|

ANURAG.CHAND@GMAIL.COM
B-706 ENGINEERS PARK
OMEGA-1
GREATER NOIDA
GAUTAMBUDHA NAGAR
UTTAR PRADESH
| 201308

Post Office:
District:
State :
Pin Code :

4. Gender :

| MALE

5. Marital Status :

| UNMARRIED

6. Citizenship :

| A CITIZEN OF INDIA(1)

7. Mother tongue :

| HINDI

8. (a) Date of Birth

(b) Claimed Age relaxation(Enclose
documentary evidence in support
of your claim)

| 23-06-88

9. Place of Birth :
Town/Village
District
State

| No

| NOIDA
| GAUTAMBUDHA NAGAR
| UTTAR PRADESH

| GENERAL (4)
10. (a) Community
Note 1: Candidate belonging to OBCs but coming in the 'Creamy Layer' and thus not being entitled to OBC
reservation should indicate their community as 'General Category (others) Code No.4'.
Note 2: Candidates belonging to neither SC,ST nor OBC Communities should write 'General'
Category(Others) Code No.4' against the column of community and not leave it blank.'.
Note 3: 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 4: In case you are a 'SC, ST or OBC' candidate, enclose a copy of certificate in support of your claim.

Roll No. :- 497585

| Candidate Signature :

Page No. 3/9

11. Choice of Centre for Examination

| DELHI

12.(i)(a)Do you hail from Arunachal Pradesh/

Manipur/Meghalaya/Mizoram/Nagaland/
Sikkim and are claiming exemption
from appearing in INDIAN LANGUAGE
FOR PAPER A?
| NO
(b)Indian Language for Paper A
| HINDI
(ii) Optional Subject for paper VI & VII
| GEOGRAPHY
13. (a)Language Medium for Examination
for Paper I to Paper VII (Essay,General
Studies and for Optional Subject as
at (ii) of col.12 above)

| ENGLISH

Note : In case of candidates opting for literature in any of the Indian Language as optional subject for papers
VI & VII , they would have to write these two papers (VI & VII) in the script specified for that particular
language as given in Annexure IV of Instructions to candidate.
(b)Language Medium for Interview
Test(c.f. para 27 of the Instructions)
to Candidates)

| ENGLISH

14. (a) Whether you are a Physically

Challenged Candidate

| 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,the post held
by him (if retired, indicate 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, indicate the post held
by her at the time of her retirement)
|
Roll No. :- 497585

N M SHARMA
NUTAN SHARMA
A CITIZEN OF INDIA
A CITIZEN OF INDIA
B-706 ENGINEERS PARK
OMEGA-1
GREATER NOIDA
GAUTAMBUDHA NAGAR
UTTAR PRADESH
201308
B-706 ENGINEERS PARK
OMEGA-1
GREATER NOIDA
GAUTAMBUDHA NAGAR
UTTAR PRADESH
201308
SERVICE
YOGA TEACHER

ADDITIONAL GENERAL MANAGER

TEACHER

| Candidate Signature :

Page No. 4/9

(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

RS.1000000
RS.100000
DHANBAD
JHARKHAND
MUNGER
BIHAR

16.Whether passed Degree or equivalent examination

| YES (Enclose copy of the Certificate )

17. Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:Examination
Passed

Class/ Percentage
CGPA
Year of
Division
of
Score Out of
/Grade Marks(%)
Passing

10th or Equivalent

1st

12th or Equivalent

1st

Graduation or
Equivalent

1st

Subject(s)

Name of
School/College
/Institution

Name of
Board/University

96.4

2003 English,Science,Math DAV Public School

s,Sanskrit
91.4
2005 Physics,Chemistry,M Delhi Public School
aths,English,Comput
er Science
Stream at Graduation Level :-ENGINEERING
9.08
10
2010
Electronics and
NIT Rourkela
Instrumentation

CBSE
CBSE

NIT

18. Were you ever Employed :

| YES
Details of your employment of any kind(in chronological order -till date):Designation/
Monthly
Whether
Period
Name of
Place of employment
Position
remuneration
Permanent/
From
To
employer/
(Address)
(Total) in Rs.
Temporary/
Organisation/
Ad hoc etc.
Firm/Individual
OPERATION
ENGINEER

35000

PERMANENT

19. Please give Particulars of:(a) Particulars of prizes,medals

scholarships,etc.
(b) Team/Games/Sports/N.C.C.
/Hitchhiking/Mountaineering etc.
(c) Position(s) of distinction Leadership
held in School/College
(d) Other extra curricular activities and
interests (Such as hobbies etc.)

01-08-2010

21-12-2011

NTPC LTD

DADRI,GAUTAMBUDH
NAGAR

| ALL INDIA TALENT SEARCH SCHOLAR,WON PRIZES IN

COLLEGE TECH-FESTIVAL
|
| CO-LEAD OF CII YOUNG INDIA,NIT ROURKELA
CHAPTER
| YOGA AND MEDITATION

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.
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 to 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.
Roll No. :- 497585

| Candidate Signature :

Page No. 5/9

The Candidates are therefore advised to excerise due diligence while filling up the above preferences.
State Cadres

Order of preference

ANDHRA PRADESH
AGMUT
ASSAM,MEGHALAYA
BIHAR
CHHATTISGARH
GUJRAT
HARYANA
HIMANCHAL PRADESH
JAMMU & KASHMIR
JHARKHAND
KARNATAKA
KERALA
MADHYA PRADESH
MAHARASHTRA
MANIPUR TRIPURA
NAGALAND
ORISSA
PUNJAB
RAJASTHAN
SIKKIM
TAMILNADU
UTTARAKHAND
UTTAR PRADESH
WEST BENGAL

IAS
10
1
21
18
17
2
14
7
22
15
11
8
12
3
24
23
6
13
5
20
9
4
16
19

IPS
10
1
21
18
17
2
14
7
22
15
11
8
12
3
24
23
6
13
5
20
9
4
16
19

21. Your order of preference against the Services/Posts given below , for which you would like to be
considered for appointment .,
Note : It is clarified that the below order of services does not reflect their relative importance in the
eyes of the Govt. and the candidates are advised to use their discretion while indicating preferences for
various services.
S.N.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

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"

Roll No. :- 497585

| Candidate Signature :

Order of Preference
1
2
0
13
5
3
12
4
16
8

Page No. 6/9

11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.

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 Island,Lakshadweep,Daman&Diu and Dadra &
Nagar Haveli Civil Service,Group "B"
The Delhi ,Andaman and Nicobar Island,Lakshadweep,Daman&Diu and Dadra &
Nagar Haveli Police Service,Group "B"
Pondicherry Police Service , Group "B"

22. Have you ever been debarred by

any Public Service Commission
or SSC from any of their
Examinations/Selections?

| NO

23. Whether you have been selected or

applied for U.P.S.C. Examination
/Recruitment:-

| YES

11
6
7
17
10
9
18
15
14
0
19
0
0

Details of other application for Examination/Recruitment held/to be held by UPSC :Name of

Examination/Post

Month and year of

Examination
/Advt./No. /Item
No. for Recruitment

Roll. No.

Whether you appeared

at the
Examination/Interview

Whether you were

recommended for
appointment

CIVIL SERVICES EXAM

2012

271965

YES

NO

24. How many times have you appeared

at the Civil Services(P)
Examination so far, including the current
Examination held in May,2013

|2

25. Details of examination in which you have appeared including CS(P),2013

Year
2012
2013
Roll No. 271965
497585

26. Have you ever accepted allocation

to a Service/Post on the basis
of Civil Services Examination
held in earlier years?
27. State of Domicile

| NO
| DELHI

28. Amount of CRF stamp pasted

| Rs. 200

Roll No. :- 497585

| Candidate Signature :

Page No. 7/9

29. List of Enclosures sent by the candidate:--->Attested/Certified Copy of certificate of Age.
--->Attested/Certified Copy of the certificate of educational qualifications.

Roll No. :- 497585

| Candidate Signature :

Page No. 8/9

DECLARATION TO BE SIGNED BY THE CANDIDATE
I, hereby declare that all statements and entries made in columns 1 to 29 of this application are true,
complete and correct to the best of my knowlege and belief. I have read rule 14 of the Rules of the
Examination and understand that in the event of any information being found false or incorrect or
ineligibility being detected before or after the examination,action can be taken against me by
the Commission.
I further declare that I fullfill all the eligibility conditions regarding age limits, educational qualifications
etc.prescribed for admission to the Examination. I have not exhausted the number of attempts admissible
to me under the rule 4 of the Rules of the Examination.
I have not with hold any information required as per this proforma.
I have read the rules and instructions carefully and I hereby undertaken to abide by them.
* I have informed my Head of the Office/Department in writing that I have applied for this examination.

** Signature of the Candidate

Place:
Date:

*Strike of this sentence, if not applicable.

** Application not signed by candidate is liable to rejection.

Roll No. :- 497585

| Candidate Signature :

Page No. 9/9

UNION PUBLIC SERVICE COMMISSION
SUMMARY SHEET
(FOR OFFICE USE ONLY)
DATE:SESSION:-

ROLL NUMBER :NAME OF EXAMINATION :NAME :DATE OF BIRTH :OPTIONAL SUBJECT:PLACE OF BIRTH :TOWN/VILLAGE
DISTRICT
STATE

|
|
|
|
|

497585
CIVIL SERVICES(MAIN) EXAMINATION, 2013
ANURAG CHAND
23-06-88
GEOGRAPHY

| NOIDA
| GAUTAMBUDHA NAGAR
| UTTAR PRADESH

Please give Particulars of:(a) Particulars of prizes,medals scholarships,etc.

(b) Team/Games/Sports/N.C.C.
/Hitchhiking/Mountaineering etc.
(c) Position(s) of distinction Leadership held in
School/College
(d) Other extra curricular activities and interests (Such
as hobbies etc.)

| ALL INDIA TALENT SEARCH SCHOLAR,WON

PRIZES IN COLLEGE TECH-FESTIVAL
|
| CO-LEAD OF CII YOUNG INDIA,NIT
ROURKELA CHAPTER
| YOGA AND MEDITATION

Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:Examination

Passed

Class/ Percentage
CGPA
Year of
Division
of
Score Out of
/Grade Marks(%)
Passing

10th or Equivalent

1st

12th or Equivalent

1st

Graduation or
Equivalent

1st

Roll No : 497585

Powered by TCPDF (www.tcpdf.org)

35000

Name of
School/College
/Institution

96.4

2003 English,Science,Math DAV Public School

s,Sanskrit
91.4
2005 Physics,Chemistry,M Delhi Public School
aths,English,Comput
er Science
Stream at Graduation Level :-ENGINEERING
9.08
10
2010
Electronics and
NIT Rourkela
Instrumentation

Employment Details:Designation/
Monthly
Position
remuneration
(Total) in Rs.
OPERATION
ENGINEER

Subject(s)

Whether
Permanent/
Temporary/
Ad hoc etc.
PERMANENT

Period
From
To

01-08-2010 21-12-2011

Name of
Board/University
CBSE
CBSE

NIT

Name of
Place of employment
employer/
(Address)
Organisation/
Firm/Individual
NTPC LTD

DADRI,GAUTAMBUD
H NAGAR