1

PERSONAL INFORMATION QUESTIONNAIRE

1. Selection Board No. City 2. UPSC Roll Number_ _ _ _ _ _ _ _

3. Entry 4B.atch Number 5. Chest Number 6. Choice of Service _

PERSONAL & FAMILY

7. Name (in block capitals) as in the Application Form AYUSH KUMAR

8. Date of birth
Day_ _ Month Year 9. Age 17 Years Months 10. Gender Male/Female
07
11. Height
cm 12. Weight kg. 13. Marital Status Married/Single/Widower

14. Religion Hinduism / Christianity/ Islam / Sikhism / Other HINDUISM

15. Mother Tongue HINDI 16. Community General/ OBC /SC/ ST. GENERAL
17. Place of maximum residence (with state) NEELMATHA, LUCKNOW, UTTAR PRADESH
18. Present address (including state)
PATELNAGAR, NEAR SIDDHARTH PALACE, NEELMATHA, LUCKNOW, UTTAR
PRADESH, PIN - 226002

19. Permanent address (including state)

VILL KHIJIRPUR, PO GATHIA, DISTRICT GHAZIPUR, UTTAR PRADESH - 226002

20. Particulars of parents/ guardian/ brothers/ sisters:-

Income
Relation Name Age (years) Education Occupation per
Month
RAKESH KUMAR SINGH 42 GRADUATION EXSERVICEMAN RS. 22,000
Father
ARTI SINGH 40 GRADUATION HOME MAKER
Mother
Guardian
Wife '

Brother ARPIT KUMAR 17 12TH APPEARING STUDENT

Brother AKHIL KUMAR 17 12TH APPEARING STUDENT

Brother
Sister
Sister
Sister

21. Parents alive? Yes/No YES If parents not alive, your age at the time of their death Years
22. Candidate's present occupation Govt I private/ self employed STUDENT Income per Month_ _ _ _
Designation / appointment Department/ firm _
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EDUCATIONAL QUALIFICATIONS(COMMEENCING FROM MATRICULATION/ EQUIVALENT EXAMINATION)

23. Matric/ Higher Secondary

Name of institution (In full, no abberviations) KENDRIYA VIDYALAYA AMC (2ND SHIFT), LUCKNOW
Location of institution (City /town/ Name of board
village) LUCKNOW
CBSE / ICSE / State Board / Other CBSE
Type of
Govt / Medium of instruction English / Hindi / Regional
institution
private
Year of passing 2020 Overall percentage of marks obtained 94.2 Division Day scholar/ boarder
FIRST

Outstanding achievements
Subject Theroy Practical s/Sessionals Total (if any)
Max Marks Max Marks Max Marks
Marks Obtained % Marks Obtained % Marks Obtained %
ENGLISH 80 74 92.50 20 20 100 100 94 94

HINDI 80 73 91.25 20 20 100 100 93 93

MATHS 80 77 96.25 20 20 100 100 97 97

SCIENCE 80 79 98.75 20 20 100 100 99 99 AMONG THE TOP 0.1% OF

TOPPER CANDIDATES
SST 80 68 85.00 20 20 100 100 88 88

400 371 92.75 100 100 100 500 471 94.20 SCHOOL TOPPER
Total
24. Senior/ 10+2 / Equivalent
Name of institution (In full, no abberviations) KENDRIYA VIDYALAYA AMC (2ND SHIFT), LUCKNOW
Location of institution (City/ town/ Name of board
village)
CBSE / ICSE / State Board / Other _
LUCKNOW
Type of
Govt I Medium of instruction English / Hindi / Regional _
institution
private
Year of passing APPEARING Overall p ercentage of marks obtained _ _ _ _ Division Day scholar/ boarder

Outstanding achievements
Subject Theroy Practicals/Sessionals Total (if any)
Max Marks Max Marks Max Marks
Obtained % Marks Obtaine % Marks Obtained %
Marks d

Total
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· 25. Graduation
Name of Instituti on (In full, no abbreviations) - - - - - - - - --:-- - - - - - - - - - - - - - -

Location of institution (city/town/village) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Un iv er s i ty - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Course B Tech/BE/ B.Sc./ B.Com./ B.A. Branch/stream
Year of admi ssion Pursuing/completed Year of completion. Day scholar/boarder
Medium of Instruction • English/Hindi/Regional Division_ _ _ Aggregate percentage_ _

Year/ Outstanding achievements

Theory Practicals/sessionals Total
Semester (if any)
Max Marks Max Marks Max Marks
Marks Obtained % Marks Obtained % Marks Obtained %

1.
2
3
4
5
6
7
8

Total
26. PostGraduation
Name of Institution (In full, no abbreviations) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Location of institution (city/town/village) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

University - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Course M Tech/ME /M.Sc./ M.Com./ M.A. Branch/stream _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Year of admi ss ion Pursuing/completed Year of completion. Day scholar/boarder
Medium of Instruction English/Hindi/Regiona. l Division Aggregate percentage

Year/
-
Practicals/ sessionals Outstanding achievements
Semester
Theory Total (if any)
Max Marks Max Marks Max Marks
% Marks Obtained % Marks Obtained %
Marks Obtained

1.
2
3
4
Total
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SPORTS/ HOBBIES/ EXTRA CURRICULAR ACTIVITES / NCC TRAINING AND MISCELLANEOUS
27. Participation in sports
Ser Sports / game played Period Level at which palyed (school / Level for service Special achievements
college / university / district/ state candidates (unit/ (if any)
No. brigade / division /
/ national I international) corps I command
From To services)
1. VOLLEYBALL 2017 2022 REGIONAL REGIONAL LEVEL
GOLD

28. Hobbies/ interest

Ser Hobby Period Level at which participated Special achievement (if any)
No.
From To
1. SINGING 2013 2022 SCHOOL SANSKRIT GROUP SONG FIRST
PRIZE, SOLO SONG FIRST PRIZE
2. SPEAKING 2015 2022 REGIONAL VARIOUS PRIZES IN DEBATES,
ELLOCUTIONS, CLUSTER LEVEL
FIRST PRIZE
3. ACTING 2016 2022 REGIONAL SCHOOL SKIT SECOND PRIZE,
REGIONAL LEVEL SECOND PRIZE

29. Extra-curricular activites

Ser Period Level at which participated Special achievement (if any)
No. Extra curricular activ ity
From To
1. SHLOKA RECITATION 2016 2022 SCHOOL SCHOOL SENIOR LEVEL THIRD
PRIZE
2. WRITING 2015 2022 SCHOOL VARIOUS PRIZES IN ESSAY
WRITING, ARTICLE WRITING
3. OLYMPIADS 2015 2022 SCHOOL SCHOOL SECOND TOPPER

30.NCC YES
Yes/No Total training (in months) _ 24
NCC training Wing Army/ Navy/ Air Force
Division Senior / Junior _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Certificate obtained A/ B / C
_
Achievements, if any BEST CADET NOMINEE IN RDC 2018 IGC, FIRING SCORE 12/15
Position of Responsibility/Appointments Held in NCC/ Scouting/ Sports/ Sports Teams I Extra curricular Group and in
any other fie_ld SPEAKER AAND MIC COORDINATOR IN RDC 2018 IGC

PREVIOUS ATTENDANCE INSSB

31. Nature of commission applied for__________________________________Choice of service _
32. Number of chances availed for commission in Armed forces _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
33. Chances availed for commission in Armed forces :-
Se r Recommended (R)/
SSB Entry Place of SSB Date Batch & Chest No. Not Recommended (NR)/
No.
Screened Out (s / o\
1
2
3
4
5
6
7
8
9
10

Dated : _ _ _ _ _ _ _ (Signature of Candidate)