APPLICATION FORM FOR
SELECTION TEST FOR ADMISSION TO THE PRE – EXAMINATION COACHING CLASSES FOR CIVIL
SERVICES (IAS ETC.) EXAMINATION, 2021 TO BE HELD AT ASSAM ADMINISTRATIVE STAFF COLLEGE
1. Name of the Applicant : _______________________________________________
(in Block letters)
2. Father’s Name& Profession : _______________________________________________
_______________________________________________
3. Mother’s Name & Profession : _______________________________________________
_______________________________________________
4. Postal Address :
5. Permanent Address :
Name
C/o
Town / Village
Police Station
Post Office
District & State
Pin Code
Phone No./ Mobile
P.T.O.
Affix Photo
Name
C/o Town / Village
Police Station
Post Office
District & State
Pin Code
Phone No./ Mobile
(2) 6. Educational Qualification : ( Self attested copies of Mark- Sheets and Certificates to be
enclosed)
Sl. No.
Educational Qualification (Degree & above)
University Major Subject (If Any)
Total Marks
% of Marks
Class
01.
02.
7. Date of Birth : ________________________ (Enclosed attested copy of
Birth Certificate or HSLC / Equivalent Exam Certificate
showing the age or date of birth)
8. Category : (SC / ST / OBC/MOBC/Women/Economically Weaker Section &PWD ) (Enclosed attested copy of certificate obtained from the competent authority)
9. Sex :_____________________
10. Optional subject for the UPSC Main Examination, 2021 :
11. 1 (one) extra passport sized photo.
DECLARATION TO BE SIGNED BY THE APPLICANT I Shri/ Smti. (Name): _____________________________________________
do hereby declare that the information given above is correct and complete to the best of my
knowledge and belief. I undertake to abide by the instructions issued by the Director of
Training / Course Director from time to time, if I am admitted to the centre for coaching
classes. I am also aware of the fact that for any breach of discipline, I may be required to
leave the centre at short notice. Further, I undertake a pledge to submit my Preliminary
Examination Admission Card in duplicate and also inform the result on receipt of the same
from the office of the Union Public Service Commission.
Place : Signature of the Applicant Date :
Recommended
