Application Form for UPSC (Civil Services) Personality Test Financial Assistance

Scheme-2021

[Please take Printout of the Application Form, Fill in the details, scan the form with respective documents (Caste
certificate, Caste validity, Bank Passbook, DAF-II, passport size photo, Domicile and UPSC (Civil Services)
Mains Examination 2021-Admit card) and send it to E-mail ID bartiupsc18@gmail.com ]

General Information
Paste Passport size
Photo

*Full Name of Candidate: -_______________________________________________________

(Starting with Surname) (As per SSC)

*Mother’s Name ________________ *Date of Birth______________________

*Gender Male Female

*Caste Category _______________________ *Caste ___________________________

*Adhar No (UID) _______________________*Mobile Number ___________________

*Education _____________________________

*E-mail ID _________________________________________________________________

*Correspondence Address______________________________________________________
__________________________________________________________________________

*Permanent Address __________________________________________________________

__________________________________________________________________________

*Seat No: ______________________________________

(The candidate should mention UPSC Mains Examination 2021 Seat No.)

*Optional Subject________________________Medium of Examination _____________

*Bank Detail:
Account No._______________________________________

Bank Name. _______________________________________

Branch____________________________________________

IFSC Code_________________________________________
 *Are you taking any benefit of State OR Central Government
Scheme for UPSC Civil Services Personality Test Examination
For current year (if YES, specify)

*Have you taken coaching for UPSC Preparation sponsored

by BARTI, in past? YES NO

*If Yes, then please mention on below details -

 Delhi Training Program YES NO

 YASHADA, Pune YES NO

 PRE- IAS (Kolhapur, Nashik, Aurangabad, Nagpur,

Amravati and SIAC- Mumbai ) YES NO

 Six Division in Maharashtra Training Program YES NO

Undertaking of the Applicant

I, hereby confirm that the information provided in the form above is true and my application can be rejected
at any stage of the selection process if any of the above information is found to be false.
I will be suspended at any stage of the scheme in case the above information is found to be false.
Additionally, the cost of financial assistance will be recovered from me, in case the above information is
found to be false.

I Accept the Terms and conditions.

I Agree I Disagree

Date:
Place:
Signature

List of Documents required (ALL DOCUMENTS MUST BE SELF ATTESTED)–

1. Caste Certificate
2. Caste Validity Certificate
3. Domicile Certificate
4. Bank Passbook ( 1st Page)
5. DAF -II
6. UPSC ( Civil Services) Mains Examination – 2021 Admit Card
7. Scan Passport size photo

________________________**End of the Form**__________________________________