Page No.

1/8

UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM
FOR CISF AC(EXE) LIMITED DEPARTMENTAL COMPETITIVE EXAMINATION, 2020

CISF No : 110200314
Rank : Sub Inspector(GD)
CISF Unit : NDRF, ARAKKONAM

1. Name | ALTAB AHMED

2. (a) Address for correspondence to which | 04TH BN NDRF ARAKKONAM,

communication is to be sent | NEAR CISF REGIONAL TRAINING CENTER
Post Office: | POST SURAKSHA CAMPUS
District: | ARAKKONAM
State : | TAMIL NADU
Pin Code : | 631152
(b) Telephone No. with STD Code | 04177-246594
(c) Mobile No. | 8098548492
(d) Fax No. | 04177246594
(e) E-mail address | [email protected]
(f) Permanent Postal Address | HOUSE NO. 1669, NEW SAINIK VIHAR
| BEHIND SAINT PETERS SCHOOL
Post Office: | KANKER KHERA
District: | MEERUT
State : | UTTAR PRADESH
Pin Code : | 250002

3. Gender : | MALE

4. Marital Status : | MARRIED

Nationality of your spouse | INDIAN

5. Citizenship : | A CITIZEN OF INDIA(1)

6. State of Domicile : | UTTAR PRADESH

7. (a) Community | GENERAL (4)

Note 1: Candidates belonging to neither SC nor ST should write 'General' Category(Others) Code No.4'
against the column of community and not leave it blank.'.
Note 2: 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.
(b) If you belong to any of the minority | MUSLIMS
communities notified by the Government

CISF No. :- 110200314 |

 Page No. 2/8
(Muslims/Christians/Sikhs/Budhhists/Zoroastrians
(Parsis)),mention the name of minority community

8. Date of Birth | 19-03-87

9. Place of Birth :
Town/Village | DALHOUISE
District | CHAMBA
State | HIMACHAL PRADESH

10. Mother tongue : | HINDI

11. Choice of Centre for Examination : | DELHI

12. (a) Language Medium of

Examination for Essay and General
Studies in Paper I and II: | HINDI
(b) Language Medium for
Interview Test : | HINDI

13. (a) Have you passed the requisite qualifying | YES

examination, as specified in Rule-6

(b). Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:-
Examination Class/ Percentage CGPA Year of Subject(s) Name of Name of
Passed Division of Score Out of School/College Board/University
/Grade Marks(%) Passing /Institution
10th or Equivalent FIRST 68.60 2002 ENGLISH, HINDI, KENDRIYA C.B.S.E
MATHEMATICS, VIDYALAYA
SCIENCE, SOCIAL PACHMARHI
STUDIES
12th or Equivalent FIRST 66.20 2004 ENGLISH, KENDRIYA C.B.S.E
PHYSICS, VIDYALAYA SIKH
CHEMISTRY, LINES
BIOLOGY,
PHYSICAL
EDUCATION
Graduation or FIRST 7.70 10 2009 MICROWAVE, IET MJP MJP
Equivalent SATELLITE ROHILKHAND ROHILKHAND
COMM, DIP, UNIVERSITY UNIVERSITY
ENGINEERING BAREILLY
ECONOMICS

14. Present Unit Where Posted : | NDRF, ARAKKONAM

15. No of Displeasures : |0

16. No of Warnings : |0

17. (a) Name of Father | RAIS AHMED

(b) Name of Mother | KHURSHEEDA KHATOON
(c) Nationality of Father | A CITIZEN OF INDIA
(d) Nationality of Mother | A CITIZEN OF INDIA

CISF No. :- 110200314 |

 Page No. 3/8
(e) Father's present postal Address | HOUSE NO 1669 NEW SAINIK VIHAR
(If deceased give last address) | BEHIND SAINT PETERS SCHOOL
Post Office: | KANKER KHERA
District: | MEERUT
State : | UTTAR PRADESH
Pin Code : | 250002
(f) Mother's present postal Address | HOUSE NO 1669 NEW SAINIK VIHAR
(If deceased give last address) | BEHIND SAINT PETERS SCHOOL
Post Office: | KANKER KHERA
District: | MEERUT
State : | UTTAR PRADESH
Pin Code : | 250002
(g) Father's Profession: | TGT TEACHER
(h) Mother's Profession: | HOME MAKER
(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) | TGT TEACHER
(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) | HOME MAKER
(k) Annual income of your Father | RS.650000
(l) Annual income of your Mother | RS.0
(m) District to which your Father originally| BIJNOR
belongs
(n) State to which your Father originally | UTTAR PRADESH
belongs
(o) District to which your Mother originally| BIJNOR
belongs
(p) State to which your Mother originally | UTTAR PRADESH
belongs

18. (a) How many times have you appeared in

written examinations of CISF AC-LDCE so far,
including the current Examination in
,2020.(Write 1,2,3
in the opposite box as the case may be) | 2
(b) Appeared during the vacancy Year | 2011, 2020,
Appeared during the vacancy Roll no. | ,,

19. Were you ever Employed : | YES

Details of your employment(in chronological order -till date):-
Designation/ Monthly Whether Name of Place of employment
Position remuneration Permanent/ Period employer/ (Address)
(Total) in Rs. Temporary/ From To Organisation/
Ad hoc etc. Firm/Individual
SUB INSPECTOR 60000 PERMANENT 27-07-2011 TILL DATE NDRF 04TH BN NDRF
EXECUTIVE ARAKKONAM

20. Have you ever been debarred by

any Public Service Commission
or SSC from any of their

CISF No. :- 110200314 |

 Page No. 4/8
Examinations/Selections? | NO

21. Please give Particulars of:-

(a) Particulars of prizes,medals | 1. ARMY WELFARE ASSOCIATION SCHOLARSHIP IN
scholarships,etc. B.TECH. 2. RAJYA PURASKAR AWARD IN SCOUTS AND
GUIDES MOVEMENT. 3. FIRST PRIZE IN HINDI
CALLIGRAPHY. 4. FIRST PRIZE IN ATHLETICS IN
VARIOUS EVENTS.
(b) Team/Games/Sports/N.C.C. | 1. CRICKET 2. SCOUTS AND GUIDES 3. RELY RACE 400
/Hitchhiking/Mountaineering etc. METERS
(c) Position(s) of distinction Leadership | 1. CULTURAL HOUSE CAPTAIN AJANTA HOUSE IN 10
held in School/College CLASS. 2. MONITOR OF CLASS 6 TO 10.
(d) Other extra curricular activities and | NET SURFING AND JOGGING
interests (Such as hobbies etc.)

22. Whether you have been selected or

appeared for U.P.S.C. Examination
/Recruitment:- | YES
Details of other application for Examination/Recruitment held/to be held by UPSC :-
Name of Month and year of Roll. No. Whether you appeared Whether you were
Examination/Post Examination at the recommended for
/Advt./No. /Item Examination/Interview appointment
No. for Recruitment
CDS 2010 0 INTERVIEW NO

23. List of Enclosures sent by the candidate:-

--->Self-Attested/Certified Copy of certificate of Age.
--->Self-Attested/Certified Copy of the certificate of educational qualifications.
--->Certificate from Head of Department / Cadre Controlling Authority, Signed and Verified by it verifying
their eligiblity.
--->Annexure Regarding Details of punishment etc.

CISF No. :- 110200314 |

 Page No. 5/8
DECLARATION TO BE SIGNED BY THE CANDIDATE

I, hereby declare that all statements and entries made in columns 1 to 23 of this application are true,
complete and correct to the best of my knowledge and belief.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 under Rule 12 of the Rules of the examination.
Further certified that I have not availed three chances so far in competing in this examination and
information furnished by me against column 18 is correct.In case at any stage,even after my appointment
(If I am selected to the post) this information is found false or incorrect, my candidature may be
rejected/I may be reverted back to my substantive post, as the case may be, by the competent authority,
without assigning any reason thereof and also competent authority may take any appropriate discipilinary
action against me for furnishing false and incorrect information.
I have read provisions in the Rules and Notice of the Commission carefully and hereby undertake to abide.
Application not signed by the candidate will be rejected. Incomplete application will be also rejected .

* Signature of the Candidate

Place:
Date:

* Application not signed by candidate is liable to rejection.

CISF No. :- 110200314 |

 Page No. 6/8
UNION PUBLIC SERVICE COMMISSION
Certificate to be forwarded for CISF AC(EXE) Limited Departmental Competitive Examination , 2020
Roll No. ______________
(to be given by the UPSC)

1. CISF No :- | 110200314
2. Rank :- | SUB INSPECTOR(GD)
3. Name :- | ALTAB AHMED
4. Present Unit Where Posted :- | NDRF, ARAKKONAM
5. Father's Name :- | RAIS AHMED
6. Date of Birth :- | 19-03-87
7. Age as on 01.08.2020 :- | 33 Years
8. Date Of Appointment :- | 27-07-2011
9. Educational Qualification :- | B.TECH
10. Category(Gen./SC/ST) :- | GENERAL
11. No of Cash Rewards :- | 07
12. No of Commendations :- | 0
13. No of Punishments :- | As per ANNEXURE
14. No of Displeasures :- | 0
15. No of Warnings :- | 0
*16. No. of Chances of LDCE appeared in writted exam /availed and details thereof :

S.N. Appeared during vacancy Roll No. allotted Remarks

year
1 2011

2 2020

I, hereby declare that all entries/statements made in columns 1 to 16 of this application are true,complete and correct
to the best of my knowledge and belief. In the event of any information being found false or ineligibility being detected
before or after the examination,action can be taken against me by the Commission as per provisions contained under the
Rules of the Examination .
Further certified that I have not availed three chances so far in competing in this examination and information
furnished by me against column 16 is correct. In case at any stage,even after my appointment (if I am selected to the post)
this information is found false or incorrect, my candidature may be rejected/I may be reverted back to my substantive post, as
the case may be, by the competent authority , without assigning any reason thereof and also competent authority may take
any appropriate disciplinary action against me for furnishing false and incorrect information.
I have read provisions in the Rules and the Notice of the Commission carefully and I hereby undertake to abide.

Note 1 : Application not signed by the candidate will be rejected.

Note 2 : Incomplete application will also be rejected.
Signature of the Applicant
* To be filled by candidate.

CERTIFICATE FROM THE CONTROLLING OFFICER

1. The details like CISF No,Rank, Name, Date of Birth, Date of Appointment, Category, Reward & Punishment, mentioned
in the application have been verified with reference to his/her service record and found correct.
2. He/She has completed 04 years of service as on 01.01.2020 in Rank of SI(GD)/Inspector(GD).

CISF No. :- 110200314 |

 Page No. 7/8
3. No criminal case or DE or other enquiry including sexual harassment is pending.
4. Certified that the Department/Office has no objection in permitting Shri/Smt._____________________ .
for applying to the Post of _______ in CISF.It is further certified that Shri/Smt.____________________ . has not been
awarded / any punishment during his entire service career.
5. His medical categorization for the year 2019 (should be valid upto August 2020) is ____________________ as specified
in CISF circular no (145) dated 28.01.2009. Xerox copy duly self-attested is enclosed.

Place:
Date:

TO BE SIGNED BY HEAD OF OFFICE

( With Stamp )

CISF No. :- 110200314 |

 Page No. 8/8
ANNEXURE
RECRUITMENT OF ACs (GD) IN CISF THROUGH LDCE-2020

Details of Punishments (Major/Minor) in entire service

CISF No :- | 110200314
Rank :- | SUB INSPECTOR(GD)
Name :- | ALTAB AHMED
CISF Unit :- | NDRF, ARAKKONAM

S/No Date of Issue of Penalty Date of appeal, Outcome of Date of Penalty

Charge sheet. awarded by if any. apppeal with Revision awarded by
Disciplinary date. Wheather Petition, if any. Revisioning
Authority with exonerated Authority with
date of award. enhanced, or date.
reduced.
01 02 03 04 05 06 07

Signature of the Candidate

Verified by Commander

Signature of the Unit Commander

CISF No. :- 110200314 |

Powered by TCPDF (www.tcpdf.org)