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ANNEXURE TO APPLICATION FORM

PROFORMA TO BE FILLED BY OBC CANDIDATES
1.

Name of candidate

2.

Roll No.

3.

(a) Name of Father

___________________________________________

(b) Date of birth of Father

___________________________________________

(a) Name of Mother

___________________________________________

(b) Date of birth of Mother

___________________________________________

(a) Profession of Father

___________________________________________

(b) (i) If in service, whether he is/was working under

Central Govt./State Govt./Public Sector
Undertaking/Autonomous Body/Private
Organisation or somewhere else.

___________________________________________

4.

5.

___________________________________________

(ii) Name of the post to which he was appointed

by direct recruitment.
(iii) Group of the post (viz. Group A, B, C or D) to
which he was appointed by direct recruitment.
(iv) If posts in the organization are not classified as
Group A, B, C or D, whether the post to which
the father was appointed by direct recruitment is
comparable or equivalent to any group A, B, C or
D post in Govt. If yes, to which it is comparable.

____________________________________________
____________________________________________

____________________________________________

(v) Details of all the post held by Father

Name of the post and group of

the post & equivalent of post

Pay Scale of the post

Date of Appointment/
Promotion to the post

Age at the time of

appointment/promotion

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(vi) Whether the father has/had been in employment
in any International Organisation like U.N., IMF,
World Bank. If yes, duration of such employment.

6.

____________________________________________

(vii) If father is dead, date of his demise.

____________________________________________

(viii) If father suffer from permanent incapacitation,

Date from which he so suffers.

____________________________________________

(a) Whether father of the candidate holds or has ever

held a Constitutional post.

____________________________________________

(b) If yes, name of the post(s) and duration of holding

the post(s).

____________________________________________

7.

If father is/was in armed forces or in para military service, ____________________________________________

the post which he is/was holding or held at the time of
retirement/leaving the job.

8.

(a) Profession of Mother

___________________________________________

(b) (i) If in service, whether she is/was working under

Central Govt./State Govt./Public Sector
Undertaking/Autonomous Body/Private
Organisation or Somewhere else.

___________________________________________

(ii) Name of the post to which she was appointed

by direct recruitment.

____________________________________________

(iii) Group of the post (viz. Group A, B, C or D) to

which she was appointed by direct recruitment.

____________________________________________

(iv) If posts in the organization are not classified as

Group A, B, C or D, whether the post to which
the mother was appointed by direct recruitment is
comparable or equivalent to any group A, B, C or
D post in Govt. If yes, to which it is comparable.

____________________________________________

(v) Details of all the post held by Mother :-

Name of the post and group of

the post & equivalent of post

Pay Scale of the post

Date of Appointment/
Promotion to the post

Age at the time of

appointment/promotion

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(vi) Whether the mother has/had been in employment
in any International Organisation like U.N., IMF,
World Bank. If yes, duration of such employment.

9.

____________________________________________

(vii) If mother is dead, date of her demise.

____________________________________________

(viii) If mother suffer from permanent incapacitation,

date from which she so suffers.

____________________________________________

(a) Whether mother of the candidate holds or has ever

held a Constitutional post.

____________________________________________

(b) If yes, name of the post(s) and duration of holding

the post(s).

____________________________________________

10. If mother is/was in armed forces or in para military service,

the post which she is/was holding or held at the time of
retirement/leaving the job.

____________________________________

11. (A) Whether the parents of the candidate own agricultural land.

____________________________________

(B)) If Yes,
(a) Area of the irrigated land owned by father, mother and
Children put together.

____________________________________

(b) Area of the unirrigated land owned by father, mother and

Children put together.

____________________________________

(c) Statutory ceiling limit of land hold at the place where

land owned is located.

____________________________________

(d) If the land is both irrigated and unirrigated, indicate

whether condition given in clause (b)(i) of Schedule V
to the DoP&T O.M. No.36012/22/93-Estt.(CST), dated
8-9-1993 applies. Give details.

____________________________________
____________________________________

12. Annual income of father for last three years (year-wise)

(a) Income from salary

____________________________________

(b) Income from agriculture

____________________________________

(c) Income from other sources

____________________________________

(Note : Attach income-tax returns)

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13. Annual income of mother for last three years (year-wise)
(a) Income from salary

____________________________________

(b) Income from agriculture

____________________________________

(c) Income from other sources

____________________________________

(Note : Attach income-tax returns)

14. (a) Details of wealth held by parents

(b) Whether the wealth held is within the exemption limit
as prescribed in Wealth Tax Act ?
15. Whether documentary proof in support of service/status/
land holding /income from different sources property held by
parents have been attached ?

____________________________________
____________________________________

____________________________________

Information furnished above is true to the best of my knowledge and I have not concealed any relevant information. I
swear that if it is found at any stage that information furnished by me is false or that I have concealed some relevant information, I
will forfeit the claim to appointment to any service on the basis of Engineering Services Examination, 2016.

Signature of the Candidate

Place
Date .