Page No. 1/8 UNION PUBLIC SERVICE COMMISSION DETAILED APPLICATION FORM [DAF]-I CIVIL SERVICES (MAIN) EXAMINATION, 2021 RID. a Roll No.: Name: Oa Ena: Mobile: Se 1, (a) Date of Birth lone (b) Age Relaxation claimed | NO 2. (a) Address for correspondence to which | 9) uh) SNH SUH e ete ‘Communication is to be sent Post Office | City: — District: — State : | @neaenee+ Pin Code — (b) Telephone No. (with STD Code) I- (©) Mobile No. —1 (a) Fax No. | (©) E-mail address | ee ee me (® Permanent Postal Address, | A ee cr i Post Office: | City: |=. District: —— State: | @nraeree- Pin Code — 3. Gender — 4, Marital Status : | ee (If Married, Nationality of spouse) | 5. (a) Citizenship : | A CITIZEN OF INDIA(1) (b) Nationality = | INDIAN 6. Mother tongue : | OTHERS 7. Place of Birth : If born in India: | YES Post Office = City/Town/Village —— [Roll No.Page No. 2/8 District — State I” - Pincode | 8. (a) Community - Note 1: No change in the community status already indicated by candidate in his / her application form for this examination will be allowed by the Commission except in the circumstances mentioned in the Rule 26 of CSE Rules, 2021. Note 2: In case you are a SC, ST, OBC(Non Creamy Layer) or EWS' candidate, upload a scanned copy of certificate in support of your claim. For, SC/ST/OBC(Non Creamy Layer/EWS candidates, it should be issued prior to the date of closure of online application form for Civil Services (Preliminary) Examination,2021 (ie. prior to 24.03.2021). Note 3: "Income and Asset Certificate’ based on the income for Financial Year 2019-20 (i.e. for the period from st April, 2019 to 3 1st March, 2020) must only be submitted to claim the benefit of the Economically Weaker Section reservation as per the prescribed format and such candidates must meet the Income and Asset criteria issued by the Central Government. Certificate of any other Financial Year shall not be treated as valid, Note 4: In case you are an OBC candidate, OBC(Non-Creamy Layer) certificate based on the income for the inancial Years (FYs) 2019-2020, 2018-2019 and 2017-2018 must only be submitted, (b) Certificate No. —- (©) Date of issue i (d) Designation of issuing authority | Se) (©) Full address of issuing authority | SS (8) Name of the Caste as mentioned in | - the Community Certificateand =| RAJASTHAN Name of the issuing State [For SC/STIOBC Candidates} (g) State Creamy or Non Creamy Layer | Non Creamy Layer (h) Ifyou belong to any of the minority Communities notified by the Government (Musfinn/Christians’Sikhs/Buddhists! Zoroastrians[Parsi}/Jains) | NO (i) Ifyes, Name of the Minority community | 9.1.(a) Whether you are a candidate with NO Benchmark Disability (upload a scanned Certificate of disability) If yes, disability certificate form (b) Category (©) Percentage of disability as indicated in the Certificate of Disability (a) Cattificate No. (©) Date of Issue () Designation of issuing authority (g) Full address of issuing authority (h) Would you require seribe in the Examination fare —Note 1 Note 2: Note 3: Note 4: Page No. 3/8 The Persons with Benchmark Disabilities in the categories of blindness, locomotor disability (both arm affected — BA) and cerebral palsy will be provided the facility of scribe, if desired by the person. In case of other category of Persons with Benchmark Disabilities as defined under section 2(r) of the RPWD Act, 2016, the facility of scribe will be allowed to such candidates on production of a certificate to the cffect that the person concerned has physical limitation to write, and scribe is essential to write examination on behalf, from the Chief Medical Officer/ Civil Surgeon/Medical Superintendent of a Government Health Care institution as per proforma at Appendix — IV of the Notice of CSE, 2021 dated 4th March, 2021 ‘The candidates have discretion of opting for his/her own scribe or request the Commission for the same. The qualification of the Commission's scribe as well as own scribe will not be more than the minimum qualification criteria of the examination. However, the qualification of the scribe should always be matriculate or above. The Persons with Benchmark Disabilities in the category of blindness, locomotor disability (both arm affected — BA) and cerebral palsy will be allowed Compensatory Time of twenty minutes per hour of the examination, In case of other categories of Persons with Benchmark Disabilities, this facility will be provided on production of a certificate to the effect that the person concemed has physical limitation to write from the Chief Medical Officer/ Civil Surgeon/ Medical Superintendent of a Government Health Care institution as per proforma at Appendix —1V of the Notice of CSE, 2021 dated 4th March, 2021 (h)Gi) yes, "Commission's Scribe" or "Own | aw a (w) Scribe” ‘Ate youa person with Locomotor | Disability and Cerebral Palsy and having impairment in Dominant Writing Extremity Would you require any assistive | device(s) Would you require ques larger font size?” paper in | ‘Note: Larger font is only for PwBD Candidates suffering from Blindness/ Low Vision. 9.2.(a) Have you ever been recommended as a_ | NO. (b). IFyes, mention name and year of the examit PwBD candidate in the examinations conducted by the UPSC in the past? tion(s) with Roll No. ‘Name of the Examination Year of the Roll No. Examination © @) © Whether such recommendation was on | NO the basis of the Certificate of Disability NOW UPLOADED by you for the CS(M) Exam, 2021? Aficr any such recommendation by the | NO. UPSC were you ever found UNFIT) NOT RECOMMENDED by the Central Standing Medical Board or any other Medical Board constituted by the Government with regard to your physical disability? If yes, provide details thereof10. Choice of Centre for Examination JAIPUR (a), Do you want to change your Centre for | NO Main Examination? 11. (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 (ii)Indian Language for Paper A | HINDI (b) Optional Subject for paper VI & VIL | MATHEMATICS 12, (a)Language Medium for Examination for Paper I to Paper V (Essay and General Studies) | ENGLISH (b) Language Medium for Examination for Paper VI to Paper VII (Optional Subject as at (b) of Col. 11 above) | ENGLISH (c) In case of Sindhi and Santhali type of script should be indicated by the candidate (d)Language Medium for Interview ‘Test(i.e. para 27 of the Instructions) to the Candidates) | ENGLISH 13. (a) Name of Father = - (b) Name of Mother | =< (c) Nationality of Father | INDIAN (@) Nationality of Mother | INDIAN (e) Father's Profession: | GOVT. SERVICE/PUBLIC SECTOR (® Mother's Profession: | HOUSEWIFE (g) If your father is in service, the post held by him (gi) if retired indicate the post held by him at the time of his retirement otherwise fill 'NOT APPLICABLE’ _| LOWER DIVISION CLERK (h) If your Mother is in service, the post held by her (hy(i) if retired indicate the post held by her at the time of her retirement, otherwise fill 'NOT APPLICABLE’ | NOT APPLICABLE (i) Annual income of your Father \— (j) Annual income of your Mother is (k) State to which your Father originally | RAJASTHAN belongs (D District to which your Father originally | belongs (m) State to which your Mother originally | RAJASTHAN belongs Page No. 4/8 fe" No.Page No. 5/8 (n) District to which your Mother originally) 9) 9% belongs (0) Father's present postal Address (If deceased give last address) Post Office City: District: State Pin Code (p) Mother's present postal Address (If deceased give last address) Post Office City: District: State: Pin Code 8. ee ee (q) Whether your family owns or possesses any of the following assets i. S acres of agricultural land and above; ii, Residential flat of 1000 sq ft. and above; i, Residential plot of 100 sq, yards and above in notified municipalities; iv. Residential, plot of 200 sq. yards and above in areas other than the notified ‘municipalities. | YES 14.1(a) Do you possess the prescribed Educational Qualification (Vide rule-6 of the rules of the Examination)? Please upload a scanned copy of the Certificate ifthe answer is "YES" | YES (b) Certificate No. — (©) Date of issue — (@)_ Designation of issuing authority | ee (@) Full address of issuing authority _| seh ue © ee NO et =e Note : If you do not possess the prescribed educational qualification as mentioned in rule-6 of the examination your candidature is liable to be cancelled. The proof of passing the requisite examination should be dated earlier than the due date (closing date) of Detailed Application Form-1 of the Civil Services (Main) Examination, (O(¥) Do you have any basic Educational Qualification or higher qualitication obtained from a foreign institution? | No 14.2 Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation: (Please upload scanned copy of all Certificates/Degree) Examination | Class’ [Percentage [_caPA Weoraf Subjects) Nameof Nameot | [Roll No.Page No. 6/8 Passed [Division] of [SeoreOuro SchooliCollege | Board/University| sGrade| Marks(%) passing Jnstitution Toth or Equivalent) — 1 1 [10 | 2011 | Hindi, English, [The Rajasthan School] CBSE lathematics, ee, Social ience, IT 1th or Equivalent) 1 8 2013 | Mathematics, — |The Rajasthan School] CBSE English, Physics, ‘Chemistry, Physical Education Siream at Graduation Level: ENGINEERING B.TECH, 7 658] 10 | 2018 | Electrical Indian Tnstitute of INDIAN Engineering | Technology Ropar | INSTITUTE OF TECHNOLOGY ROPAR 15.(i) Have you ever been employed?: | NO 16, Have you ever been debarred by the UPSC from any of its Examinations/Selections? | No 17. Whether you have ever applied for U.P.S.C. Examination /Recruitment- | YES Details of other application for Examination/Recruitment heldto be held by UPSC | ‘Name of ExaminationPost | Monthand | Roll. No. [Whether you] Whether you] Whether you] Whether you) Whether year of appeared at | appeared at vere recom oined/2ppoi| continuing Examination| tne fine Interview] ended for | nied jill date or re (Advt 'Examination| eppoinimen signed(with INovItem No. date) for Recruitment ‘CIVIL SERVICES (PRE) __[JUNE, 2019] 0834806 | YES YES NO NO NA CIVIL SERVICES (MAIN) SEPTEMBE] 0834806 | YES ‘YES ‘NO NO NA R209 ‘CIVILSERVICES (PRE) [OCTOBER] 1136888 | YES YES NO NO NA 2020 CIVIL SERVICES (MAIN) [JANUARY] 1136888 | YES YES NO NO NA 2021 INDIAN FOREST SERVICE (PRE) |JUNE, 2019] 0834806_| YES NO- NO- NO NA INDIAN FOREST SERVICE (MAIN) DECEMBE]| 0834806 | YES NO ‘NO NO NA R209 18(a). How many times have you appeared at the Civil Services(Pre) Examination so far, including the current Examination held in October, 2021 | 3 18(b). Details of Examination in which you have appeared including CS(P), 2021 Year 2019 2020 2021Page No. 7/8 Roll No. [0834806 [1136888 [1118762 19, Have you ever accepted allocation toa Service/Post on the basis of Civil Services Examination held in earlier years? | NO (a). Year of the Civil Services Examination on the basis of which you had been last allocated to service/post \ (b). Name of service/post to which allocated \ (©). Your Roll No. for the exami (a). Whether you were appointed/joined Service? \ (c). Whether you are continuing in that Service/Post? | (H. Ifyou have resigned from such post/service Mention date of acceptance of the resignation by the Competent authority \ 20. Fee Payment Details (Subject to Verification) == Application No. (—— Transaction-Id i Paid (in Rs.) i- Agency Name ed | Mode of Payment Details of Fee paid:Candidates applying (excepting Female/SC/ST/PwBD candidates who are exempted from payment of fee) for Civil Services (Main) Examination are required to pay a fee of Rs.200/- (Rupees Two Hundred only) either by depositing the money in any Branch of SBI by cash, or by using Net Banking facility of SBI or by using Visa/Master/Rupay Credit/Debit card. 21, Photo-ID Proof | —— << 22, List of Scanned documents uploaded by the candidate:- --> Scanned Copy of proof of date of birth as prescribed in Para below Note IV under Rule 5 of the rules for the exam. {Col. 1(a) of this form} -> Scanned Copy of Certificate in support of claim to belong to SC / ST / OBC (Non Creamy Layer)/EWS. (details of which have been indicated in Col.8), UNDERTAKING FOR OBC/EWS CANDIDATES, as applicable --> Scanned Copy of the certificate of graduation or equivalence educational qualifications (including a copy of recognition letter / equivalence certificate from AIC/UGC, if applicable)[Col. 14 of this form] -> Copy of the selected Photo ID Proof (viz. Aadhaar Card, Voter Card, PAN Card, Passport, Driving Licence or any other Photo ID Proof issued by the Central/State Government.) fen —_— | Cece]Page No. 8/8 DECLARATION BY THE CANDIDATE I hereby declare that all statements and entries made in all the columns of this application are true, ‘complete and correet to the best of my knowledge and belief 2, That Ihave read Rule 19 of the Rules of the Civil Services Examination, 2021 published in Part 1— Section 1 of the Gazette of India Extraordinary dated 4th March, 2021 and understand that in the event of any information being found false or incorrect or ineligibility being detected before or after the examination, or flouting of any instructions given by the Commission alongwith e-Admit card Question — cum — Answer Booklets/ e-Summon letter ete action can be taken against me by the Commission, 3, That I further declare that I fulfil all the eligibility conditions regarding age limits, educational qualifications ete. prescribed for admission to the Examination. I have not exhausted the number of attempts admissible to me under the Rule 3 of the Rules of the Examination, 2021 4, That I have not withheld any information required as per this Detailed Application Form- 1 5. Ihave thoroughly scrutinised the list of scanned documents as enumerated in Column 21 and 22 of the DAF-1 and uploaded scanned copies ofall the documents relevant for me. 6, That I have read the Rules of Examination and the instructions carefully and I hereby undertake to abide by them, 7. That I have informed my Head of the Office/Department in writing that I have applied for this examination as required in Col. 15 (i) of the DAF-L Tgmature of the Candi [Note: Online submission of the DAF-I by the candidate within prescribed time period is construed as his/her signed applicaion| [Roll No.