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

E-mail

Phone No./ Mobile

P.T.O.

Affix Photo

Name

C/o Town / Village

Police Station

Post Office

District & State

Pin Code

E-mail

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 :