Demand Draft of Rs.

100/- in favour of Secretary Hamdard Education Society

HAMDARD STUDY CIRCLE

APPLICATION FOR ADMISSION
Form No.
To
The Director
Hamdard Study Circle
Talimabad, Sangam Vihar
New Delhi 110 062

Affix your recent

passport size
photograph

Sir,
I wish to appear in the Civil Services Examination and would be grateful if I could be admitted to the
Hamdard Study Circle for coaching and guidance. I shall abide by the rules and regulations of the Study Circle
enforced from time to time. My admission may be cancelled anytime without notice if my performance and/or
conduct are not found satisfactory.
(USE CAPITAL LETTERS)
1. Name Mr / Ms
(Surname first)
2. Fathers /
Husbands Name
3.

Date of Birth

Date

Month

Year

4. Enter appropriate code in the box for category and community (attach attested copy of certificate in case of SC
or OBC)
Category

1. General

2. S.C.

3. O.B.C.

Community

4. Muslim

5. Hindu

6. Christian

7. Sikh

5. Fathers / Guardians Occupation: _________________

and
6. Total Annual Income Rs. ______________________
7

Mailing Address

e-mail ID
Telephone No.
8

PIN

Permanent Address

Telephone No.
9. Educational Qualifications

PIN

8. Any other

Examination passed

Year

Board / University

Div.

Subjects

High School
Higher Secondary (+2)
Graduation
Post - Graduation
Any other
10. Have you appeared in UPSC Civil Services Examinations earlier?
If yes, give details below in ascending chronological order
Examination
Year(s)
Preliminary

Yes/No
Roll No.

Result

Main
Personality
11. Have you received coaching at H.S.C. earlier? If yes, give year(s) and details

12. Have you received coaching in any other coaching Institute, if yes, please mention the name of the Institute
and year(s)
13. Have you received stipend for coaching from Ministry of S.J. & Empowerment earlier? If yes, write details
14. For which Examination coaching do you wish to be admitted to H.S.C.? Please strike out those not applicable
CS Preliminary / CS Main / CS Personality
Year
15. Choice of Centre for H.S.C. Admission Test
(Enter appropriate code in the box)

1. Delhi
2. Chennai
3. Patna 4. Calicut
5. Thiruvananthapuram 6. Kolkata
7. Hyderabad
8. Guwahati 9. Bidar
10. Allahabad
12. Srinagar 13. Bhopal
14. Mumbai
16. Optional Subject(s) offered for Civil Services Examination
Main
Studied the above subject(s) offered upto
(Enter appropriate code in the box)
17. Medium of language in Examination
(Enter appropriate code in the box)

1. High School
3. Master level
1. English

2. Bachelor level
4. Never studied

2. Hindi

3. Urdu

4. Any other

18. UPSC Roll No. __________________

Date:____/_____/________

Place:_______________

Signature

HAMDARD STUDY CIRCLE

Talimabad, Sangam Vihar, New Delhi-110062
Tel. No. 2604 8848, 2604 3732

Hall Ticket (For Centre)

Affix your self
attested recent
passport size photo

Roll No: _____________________________

(To be filled in by the Office)
Centre: ________________________

1. Name:

_______________________________________________

3. Father's/Husbands Name:

_______________________________________________

5. Mailing Address:

_______________________________________________
_______________________________________________
__________________________ Pin__________________

Phone No.

_______________________________________________

(Signature of Applicant)

(Signature of Invigilator)

Cut Here
HAMDARD STUDY CIRCLE
Talimabad, Sangam Vihar, New Delhi-110062
Tel. No. 2604 8848, 2604 3732

Hall Ticket (For Candidate)

Roll No: ________________
(To be filled in by the Office)

Affix your self

attested recent
passport size photo

Centre: ___________________
1. Name:

_______________________________________________

3. Father's/Husbands Name:

_______________________________________________

5. Mailing Address:

_______________________________________________
_______________________________________________
_____________________________Pin________________

Phone No.
(Signature of Applicant)

_______________________________________________
(Signature of Invigilator)