Page No.

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UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM [DAF]-I
CIVIL SERVICES (MAIN) EXAMINATION, 2019

RID. : 11911467493
Roll No. : 7905723
Name : TANYA SHARMA
Email : tanyagoswami11@gmail.com
Mobile : 9410001643

1. (a) Date of Birth | 01-07-88

(b) Age Relaxation claimed | NO
(c) Nature of Age relaxation claimed |
(If yes, upload a scanned documentary proof/ documentary evidence in support of your claim)

2. (a) Address for correspondence to which | DR. NISHI SHARMA, NEAR KALI MANDIR
Communication is to be sent | JALESAR ROAD
Post Office: |
City: | FIROZABAD
District: | FIROZABAD
State : | UTTAR PRADESH
Pin Code : | 283203
(b) Telephone No. (with STD Code) | -
(c) Mobile No. | 9410001643
(d) Fax No. |
(e) E-mail address | TANYAGOSWAMI11@GMAIL.COM
(f) Permanent Postal Address | DR. NISHI SHARMA, NEAR KALI MANDIR
| JALESAR ROAD
Post Office: |
City: | FIROZABAD
District: | FIROZABAD
State : | UTTAR PRADESH
Pin Code : | 283203

3. Gender : | FEMALE

4. Marital Status : | UNMARRIED

(If Married, Nationality of spouse) |
5. (a) Citizenship : | A CITIZEN OF INDIA.(1)
(b) Nationality : | INDIAN

6. Mother tongue : | HINDI

7. Place of Birth :
If born in India: | YES

Roll No. :- 7905723 |

 Page No. 2/8
Post Office | FIROZABAD
City/Town/Village | FIROZABAD
District | FIROZABAD
State | UTTAR PRADESH
Pincode | 283203

8. (a) Community | EWS (5)

Note 1: Candidate belonging to OBCs but coming in the 'Creamy Layer' and thus not being entitled to OBC
reservation should indicate their community as 'General Category(others)(Code No.4)'.
Note 2: Candidates belonging to neither SC,ST,OBC communities nor EWS should write 'General Category'
(Others) Code No.4' against the column of community and not leave it blank.'.
Note 3: 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 23 of CSE Rules, 2019.
Note 4: 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) candidates, it should be
issued prior to the date of closure of online application form for Civil Services (Preliminary)
Examination,2019 (i.e. prior to 19.03.2019). For EWS candidates, it should be issued prior to 1st
August,2019.
(b) Certificate No. | 165NN
(c) Date of issue | 29-07-2019
(d) Designation of issuing authority | TEHSILDAR
(e) Full address of issuing authority | TEHSILDAR,SADAR,FIROZABAD

(f) Name of the Caste as mentioned in | ()

the Community Certificate and |
Name of the issuing State
(g) If you belong to any of the minority
Communities notified by the Government
(Muslim/Christians/Sikhs/Budhists/
Zoroastrians[Parsi]/Jains) |
(h) If yes, 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 |

(c) Percentage of disability as indicated in |

the Certificate of Disability
(d) Are you Ortho with locomotor |
disability and cerebral palsy having
impairment of dominant(writing
extremity) ?
(e) Certificate No. |
(f) Date of Issue |
(g) Designation of issuing authority |
(h) Full address of issuing authority |

Roll No. :- 7905723 |

 Page No. 3/8
(i) Would you require scribe in the |
Examination
Note 1: 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
effect that the person concerned has physical limitation to write, and scribe is essential to write examination
on his/her 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, 2019 dated 19th
February, 2019.
Note 2: The candidates have discretion of opting for his/her own scribe or request the Commission for the same.
Note 3: 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.
Note 4: 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 concerned 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 – IV of the Notice of CSE, 2019 dated 19th
February, 2019.
(i)(a) If yes, "Commission's Scribe" or "Own |
Scribe"
(j) Would you require any assistive |
device(s)
(k) Would you require question paper in |
larger font

Note: Larger font is only for PwBD Candidates suffering from Blindness/ Low Vision.
9. 2. (a) Have you ever been recommended as a | NO
PwBD candidate in the examinations
conducted by the UPSC in the past?

(b). If yes, mention name and year of the examination(s) with Roll No.
Name of Examination Year of Examination Roll No.

(c) Whether such recommendation was on | NO

the basis of the Certificate of Disability
NOW UPLOADED by you for the
CS(M) Exam, 2019?
(d) After 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?
(e) If yes, provide details thereof |

10. Choice of Centre for Examination | DELHI

11. (a) Do you hail from Arunachal Pradesh/

Roll No. :- 7905723 |

 Page No. 4/8
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 & VII | SOCIOLOGY

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 Candidates) | ENGLISH

13. (a) Name of Father | MADHAN MOHAN SHARMA

(b) Name of Mother | NISHI SHARMA
(c) Nationality of Father | INDIAN
(d) Nationality of Mother | INDIAN
(e) Father's Profession: | RETIRED
(f) Mother's Profession: | HOUSEWIFE
(g) If your father is in service, the post held by him
(g)(i) if retired, indicate the post held
by him at the time of his retirement | SERGEANT INDIAN AIR FORCE
(h) If your Mother is in service,the post held by her
(h)(i) if retired, indicate the post held
by her at the time of her retirement | HOUSE WIFE
(i) Annual income of your Father | RS.244000
(j) Annual income of your Mother | RS.0
(k) State to which your Father originally | UTTAR PRADESH
belongs
(l) District to which your Father originally | FIROZABAD
belongs
(m) State to which your Mother originally | UTTAR PRADESH
belongs
(n) District to which your Mother originally| FIROZABAD
belongs
(o) Father's present postal Address | DR. NISHI SHARMA, NEAR KALI MANDIR
(If deceased give last address) | JALESAR ROAD
Post Office: |
City: | FIROZABAD
District: | FIROZABAD
State : | UTTAR PRADESH

Roll No. :- 7905723 |

 Page No. 5/8
Pin Code : | 283203
(p) Mother's present postal Address | DR. NISHI SHARMA, NEAR KALI MANDIR
(If deceased give last address) | JALESAR ROAD
Post Office: |
City: | FIROZABAD
District: | FIROZABAD
State : | UTTAR PRADESH
Pin Code : | 283203

(q) Whether your family owns or possesses

any of the following assets.
i. 5 acres of agricultural land and above;
ii. Residential flat of 1000 sq ft. and above;
iii. 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. | NO

14.1(a) Do you possess the prescribed Educational

Qualification (Vide rule-7 of the rules of the Examination)?
Please upload a scanned copy of the Certificate
if answer is "YES" | YES
(b) Certificate No. | B.TECH011657
(c) Date of issue | 07-12-2010
(d) Designation of issuing authority | VICE CHANCELLOR
(e) Full address of issuing authority | G.B.T. UNIVERSITY,LUCKNOW,UTTAR PRADESH

Note : If you do not possess the prescribed educational qualification as mentioned in rule-7 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-I of the Civil
Services (Main) Examination.

(f)(i) Do you have any basic Educational

Qualification or higher qualification
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 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 78 2003 SOCIAL SCIENCE, MGM SR.SEC SCHO CBSE
MATH,SCIENCE,E OL,DHOLPURA
NGLISH,HINDI
12th or Equivalent FIRST 71.2 2005 PHYSICS,MATH,BI MGM SR.SEC SCHO CBSE
OLOGY,CHEMIST OL,DHOLPURA
RY.ENGLISH
Stream at Graduation Level :-- ENGINEERING
B. TECH. FIRST 73.54 2010 COMPUTER DR.K.N.MODI GAUTAM

Roll No. :- 7905723 |

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SCIENCE AND INSTITUTE OF TEC BUDDHA
ENGINEERING HNOLOGY,MODINA TECHNICAL
GAR,GHAZIABAD UNIVERSITY,
LUCKNOW, U.P.

15.(i) Have you ever been employed? : | YES

If yes, Are you in

Government/Public Enterprise | NO

If yes, Date of intimation in writing

to your Head of Office/Department
regardingappearing in Civil Services
Examination 2019 | 00-00-00

Note: The candidates employed in Government/Public Sector Enterprise/Government Autonomous Bodies

must ensure that they have intimated their parent Department before applying for this Examination with
proof of receipt by the Department. If it found, that the candidates have not done the same, their
candidature is liable to be rejected forthwith without any further notice.

Details of your employments (in chronological order till date)

Designation/Posi Monthly Whether Perman Period Name of Place of Employment
tion remuneration ent/Temporary/ From To employer/ (Address)
(Total) in Rs. Ad hoc etc. Organisation/
Firm/Individual
ASSISTANT 15000 TEMPORARY 02-08-2013 11-06-2016 AMARDEEP FIROZABAD
PROFESSOR COLLEGE OF
ENGINEERING
AND
MANAGEMENT

15.(ii) Have you been self-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:- | NO

18(a). How many times have you appeared

at the Civil Services(P) Examination
so far, including the current
Examination held in June, 2019 |4

18(b). Details of Examination in which you have appeared including CS(P), 2019
Year 2016 2017 2018 2019

Roll No. :- 7905723 |

 Page No. 7/8
Roll No. 0 0 0 7905723

19. Have you ever accepted allocation

to a 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 |
(c). Your Roll No. for the examination |
(d). Whether you were appointed/joined
Service? |

(e). Whether you are continuing in that

Service/Post? |

(f). If you have resigned from such post/service

Mention date of acceptance of the resignation
by the Competent authority |

20. Fee Payment Details (Subject to Verification) :-

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 | PAN CARD (XXXXXX769C)

22. List of Scanned documents uploaded by the candidate:-

--> Scanned Copy of proof of date of birth as prescribed in Para below Note V under Rule 6 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
, UNDERTAKING FOR OBC and EWS CANDIDATES[Col. 8(a) of this form]
--> 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.)

Roll No. :- 7905723 |

 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 correct to the best of my knowledge and belief.

2. That I have read Rule 14 of the Rules of the Civil Services Examination, 2019 published in Part I –
Section 1 of the Gazette of India Extraordinary dated 19th February, 2019 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 etc.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 etc. prescribed for admission to the Examination. I have not exhausted the number of
attempts admissible to me under the Rule 4 of the Rules of the Examination, 2019.

4. That I have not withheld any information required as per this Detailed Application Form- I.

5. I have thoroughly scrutinised the list of scanned documents as enumerated in Column 21 and 22
of the DAF-I and uploaded scanned copies of all 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-I.

Signature of the Candidate

[Note: Online submission of the DAF-I by the candidate within prescribed time period is
construed as his/her signed applicaion]

Roll No. :- 7905723 |

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 Page No. 1/12

UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM - II
CIVIL SERVICES(MAIN) EXAMINATION, 2019

RID. : 11911467493
Roll No. : 7905723
Name : TANYA SHARMA
Email : Tanyagoswami11@gmail.com
Mobile : 9410001643

1. Mother tongue : | HINDI

2. Place of Birth :
If born in India: | YES
Post Office | FIROZABAD
City/Town/Village | FIROZABAD
District | FIROZABAD
State | UTTAR PRADESH
Pincode | 283203

3. (a) Name of Father | MADHAN MOHAN SHARMA

(b) Name of Mother | NISHI SHARMA
(c) Nationality of Father | INDIAN
(d) Nationality of Mother | INDIAN
(e) Father's Profession: | RETIRED
(f) Mother's Profession: | HOUSEWIFE
(g) 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) | SERGEANT INDIAN AIR FORCE
(h) 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) | HOUSE WIFE
(i) Annual income of your Father | RS.244000
(j) Annual income of your Mother | RS.0
(k) State to which your Father originally | UTTAR PRADESH
belongs
(l) District to which your Father originally | FIROZABAD
belongs
(m) State to which your Mother originally | UTTAR PRADESH
belongs
(n) District to which your Mother originally| FIROZABAD
belongs
(o) Father's present postal Address | DR. NISHI SHARMA, NEAR KALI MANDIR
(If deceased give last address) | JALESAR ROAD
Post Office: |

Roll No. :- 7905723 |

 Page No. 2/12
City: | FIROZABAD
District: | FIROZABAD
State : | UTTAR PRADESH
Pin Code : | 283203
(p) Mother's present postal Address | DR. NISHI SHARMA, NEAR KALI MANDIR
(If deceased give last address) | JALESAR ROAD
Post Office: |
City: | FIROZABAD
District: | FIROZABAD
State : | UTTAR PRADESH
Pin Code : | 283203

(q) Whether your family owns or possesses

any of the following assets.
i. 5 acres of agricultural land and above;
ii. Residential flat of 1000 sq ft. and above;
iii. 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. | NO

4. 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 78 2003 SOCIAL SCIENCE, MGM SR.SEC SCHO CBSE
MATH,SCIENCE,E OL,DHOLPURA
NGLISH,HINDI
12th or Equivalent FIRST 71.2 2005 PHYSICS,MATH,BI MGM SR.SEC SCHO CBSE
OLOGY,CHEMIST OL,DHOLPURA
RY.ENGLISH
Stream at Graduation Level :-- ENGINEERING
B. TECH. FIRST 73.54 2010 COMPUTER DR.K.N.MODI GAUTAM
SCIENCE AND INSTITUTE OF TEC BUDDHA
ENGINEERING HNOLOGY,MODINA TECHNICAL
GAR,GHAZIABAD UNIVERSITY,
LUCKNOW, U.P.

5. Higher Educational Qualifications : Commencing with Post Graduation or equivalent examination :-

Examination Class/ Year of Date of Likely date CGPA Percentag Subject(s) College/Institution Board/
Passed Division Passing Joining of Score Out of e University
/Grade Completion of
Marks(%)
M.TECH. FIRST 2013 02-09-11 15-07-2013 8.44 10 COMPUTER G.L.A UNIVERSITY, G.L.A UNIVER
SCIENCE AND MATHURAU.P. SITY,MATHUR
ENGINEERING AU.P.

6. Having regard to answers given against

columns 1, 2, 3, 4 & 5 which is the State
/Union Territory that you would claim

Roll No. :- 7905723 |

 Page No. 3/12
as your home State/U.T. | UTTAR PRADESH

7. Please give Particulars at the University/State/National Level in respect of:-

(a)Prizes, Medals, Scholarships etc. | PARTICIPATED AT STATE LEVEL YEAR-2000

AND NATIONAL LEVEL YEAR-2001 OF
NATIONAL CHILDREN SCIENCE CONGRESS.
(b) Sports/N.C.C. etc. | NIL
(c) Position(s) of distinction Leadership held in | TEAM LEADER AT STATE AND NATIONAL
School/College LEVEL FOR NATIONAL CHILDREN SCIENCE
CONGRESS,SECRETARY AND DISTRICT
INTERACT REPRESENTATIVE OF INTERACT
CLUB FOR YEAR 2002-03, STUDENT
VOLUNTEER IN ORGANIZING
INTERNATIONAL CONFERENCE -2013 AT G.L.A
UNIVERSITY
(d) Other extracurricular activities and interests (Such | HELPING STRAY ANIMALS, WORK AS
as hobbies etc.) VOLUNTEER IN ORGANIZING SOCIAL
AWARENESS CAMPS REGARDING HUMAN
HEALTH AND ANIMAL WELFARE,
PRACTICING BASIC YOGA

Roll No. :- 7905723 |

 Page No. 4/12
8. (A)Indicate below your order of preference for Zone and State Cadre within zones for which you would like to be considered for allotment in case you are selected for Indian
Administrative Service.

Note 1 : For allocation to Home cadre against an Insider vacancy, a candidate is mandatorily required to click 'Yes' otherwise he/she shall not be considered for his/her
Home cadre at all in case he/she opted 'No'.
Note 2 : Candidates are advised to visit the website of Department of Personnel & Training at the link https://cseplus.nic.in/Home/CadreAllocation for perusing the Cadre
Allocation Policy-2017. They are also advised to go through the details of the Cadre Allocation Policy 2017 extremely carefully before submitting their preferences for
Zones as well as Cadres thereunder. The preferences once opted and submitted cannot be modified or changed at a later stage. Therefore, the candidates are advised to
exercise due diligence while filling up the preferences for Zones as well as Cadres thereunder.
Note 3 : A candidate claiming benefit of reservation under Persons with Benchmark Disabilities quota has an additonal option to indicate his/her preference for any one
state/cadre(other than Home cadre) of his/her first preferred Zone as per the para 5 of Cadre Allocation Policy issued vide OM no. 13013/2/2016-AIS.I dated 5.9.2017.

Whether you want to consider your Home State Uttar Pradesh as your first preference as Home Cadre? - YES

Zones(with State Order of preference Order of Preference for State Cadre within Zone
Cadres) for Zones
Zone I 3 AGMUT Haryana Himachal Pradesh Punjab Rajasthan Uttarakhand
3 2 6 5 1 4
Zone II 1 Bihar Jharkhand Odisha Uttar Pradesh
4 3 2 1
Zone III 2 Chhattisgarh Gujarat Madhya Pradesh Maharastra
4 3 2 1
Zone IV 5 Assam-Meghalaya Manipur Nagaland Sikkim Tripura West Bengal
2 4 6 3 5 1
Zone V 4 Andhra Pradesh Karnataka Kerala Tamil Nadu Telangana
3 1 4 5 2

Roll No. :- 7905723 |

 Page No. 5/12
8. (B)Indicate below your order of preference for Zone and State Cadre within zones for which you would like to be considered for allotment in case you are selected for Indian
Police Service.

Note 1 : For allocation to Home cadre against an Insider vacancy, a candidate is mandatorily required to click 'Yes' otherwise he/she shall not be considered for his/her
Home cadre at all in case he/she opted 'No'.

Whether you want to consider your Home State Uttar Pradesh as your first preference as Home Cadre? YES

Zones(with State Order of preference Order of Preference for State Cadre within Zone
Cadres) for Zones
Zone I 3 AGMUT Haryana Himachal Pradesh Punjab Rajasthan Uttarakhand
3 2 6 4 1 5
Zone II 1 Bihar Jharkhand Odisha Uttar Pradesh
4 3 2 1
Zone III 2 Chhattisgarh Gujarat Madhya Pradesh Maharastra
4 2 3 1
Zone IV 5 Assam-Meghalaya Manipur Nagaland Sikkim Tripura West Bengal
1 4 6 3 5 2
Zone V 4 Andhra Pradesh Karnataka Kerala Tamil Nadu Telangana
3 1 4 5 2

Roll No. :- 7905723 |

 Page No. 6/12

9. Your order of preference against the Services/Posts given below , for which you would like to be
considered for appointment.
Note 1 : It is clarified that the below order of services does not reflect their relative importance in the eyes of the
Government and the candidates are advised to use their own discretion while indicating preferences for various
services.
Note 2: A candidate shall be required to mandatorily indicate order of preferences only for those services
participating in the Civil Services Examination for the year, for which he is interested to be
allocated to, in the application form for main examination.
Note 3: The services which are not required to be opted have been shown as 'NOT OPTED.'
Note 4: A candidate who is appointed to the Indian Police Service on the basis of the results of an earlier
examination and continues to be a member of that service shall not be eligible to opt for the
Indian Police Service in Civil Services Examination, 2019.

S.N. Name of Services/Post Order of Preference

1. Indian Administrative Service 01
2. Indian Foreign Service 03
3. Indian Police Service 02
4. Indian P&T Accounts & Finance Service, Group "A" 14
5. Indian Audit & Accounts Service, Group "A" 06
6. Indian Revenue Service (Customs and Central Excise),Group "A" 05
7. Indian Defence Accounts Service ,Group "A" 09
8. Indian Revenue Service, (I.T.),Group "A" 04
9. Indian Ordance Factories Service,Group "A" (Asstt. Works Manager- 19
Administration)
10. Indian Postal Service,Group "A" 15
11. Indian Civil Accounts Service ,Group "A" 11
12. Indian Railway Traffic Service,Group "A" 07
13. Indian Railway Accounts Service ,Group "A" 08
14. Indian Railway Personnel Service,Group "A" 13
15. Post of Asstt. Security Commissioner ,Group "A" in Railway Protection Force 12
16. Indian Defence Estates Service (Junior Grade) ,Group "A" 10
17. Indian Information Service ,(Junior Grade) Group "A" 17
18. Indian Trade Service,Group "A" (Grade III) 18
19. Indian Corporate Law Service ,Group "A" 16
20. Armed Forces Headquarters Civil Service ,Group 'B'(Section Officers' Grade) 24
21. The Delhi ,Andaman and Nicobar Island,Lakshadweep,Daman & Diu and Dadra & 20
Nagar Haveli Civil Service,Group "B"
22. The Delhi ,Andaman and Nicobar Island,Lakshadweep,Daman & Diu and Dadra & 21
Nagar Haveli Police Service,Group "B"
23. Pondicherry Civil Service, Group "B" 22
24. Pondicherry Police Service, Group "B" 23

10. List of Scanned documents uploaded by the candidate:

--> Documents/Certificates in support of Higher Educational Qualification (Post Graduation)/Achievements
in differents Fields/Service Experience, etc.

Roll No. :- 7905723 |

 Page No. 7/12
DETAILED APPLICATION FORM - II

DECLARATION

1. I have carefully read all the provisions under the Civil Services Examination Rules, 2019 and the guidelines for
filling up this Detailed Application Form-II and understand the same.

2. I, hereby declare that all the entries made in all the columns of this Detailed Application Form-II are my
conscious decision and I shall not request subsequently for any change in the order of preferences for the services
and the preferences for Zones/Cadres submitted by me in this Application Form.

Signature of the Candidate

Place : Name : TANYA SHARMA

Date : Roll No. : 7905723
 Page No. 8/12

EWS ANNEXURE

1. Name of the Candidate | TANYA SHARMA

2. Roll No | 7905723

3. Income Details
Relationship Name Date of PAN No. Annual income of the candidate and Whether
with the Birth his family members for the financial the
candidate year 2017-18 from all sources i.e. candidate
salary, agriculture, business, and their
profession, other sources etc. family
members,
whose
names
are
mentione
d in Col.
3(ii) file
ITRs
(i) (ii) (iii) (iv) (v) (vi)
FATHER MADHAN MOHAN 01-01-1963 AFMPG5284R SALARY :0 YES
SHARMA AGRICULTURE : 0
BUSINESS :0
PROFESSION :0
OTHER SOURCE : 423654
TOTAL INCOME : 423654
MOTHER NISHI SHARMA 07-07-1960 AYIPS8054N SALARY :0 YES
AGRICULTURE : 0
BUSINESS :0
PROFESSION :0
OTHER SOURCE : 249234
TOTAL INCOME : 249234
TOTAL FAMILY INCOME : 672888

4(A) Whether the family# of the candidate owns | NO

or possesses agricultural land
# family for this purpose will include the person
who seek benefits of reservation, his/her
parents, and siblings below the age of 18 years
as also his/her spouse and children below the
age of 18 years.

(B) If yes,

(i) Whether the agricultural land held by the |

family of the candidate is equal to or more than 5
acres

(ii) Area of the agricultural (irrigated as well |

as un-irrigated) land owned family of the candidate

Roll No. :- 7905723 |

 Page No. 9/12
Note:- If answer to 4(B)(i) is ‘Yes’: The
candidate must mention clearly how many acres
of land are held by him and his family members
separately and also the total area of the
agricultural land.. Eg. Father – 3 acres, Mother-
2 Acres, Brother [Name]-1 Acre, Total – 6 acres
etc.

(iii) Address of agricultural (irrigated as well |

as un-irrigated) land owned by family of the
candidate
# Note:- Complete Address including
location[village, Block, Tehsil, District, State
etc.] of all agricultural (irrigated as well as un-
irrigated) land owned by family of the candidate
must be mentioned separately.

5(A) Whether the family# of the candidate own | NO

residential flat(s) of 1000 Sq. ft. and above
# family for this purpose will include the person
who seek benefits of reservation, his/her
parents, and siblings below the age of 18 years
as also his/her spouse and children below the
age of 18 years.

(B) Area of the residential flat(s)# owned by the |

family of the candidate
# Note:- If answer to 5(A) is yes:- The candidate
must mention the area of all flats owned by the
family of the candidate separately. For eg. Flat 1:
1200 Sq. ft., Flat 2:- 800 Sq. ft. etc.

(C) Address of residential flat(s)# owned by the |

family of the candidate
# Note:- Complete Address[village, Block, Tehsil,
District, State etc.] of all flat(s) owned by the
family of the candidate must be mentioned
separately. For eg. Flat 1:- ABC Colony, XYZ
State; Flat 2: PQR Colony, STU State etc.

6(A) Whether the family# of the candidate own | NO

residential plot(s) of 100 Sq. yards and above in
notified municipalities
# family for this purpose will include the person
who seek benefits of reservation, his/her parents,
and siblings below the age of 18 years as also
his/her spouse and children below the age of 18
years.

(B) Area of the residential plot(s)# owned by the |

family of the candidate
# Note:- If answer to 6A is ‘Yes’: The candidate

Roll No. :- 7905723 |

 Page No. 10/12
must mention the area of all residential plot(s)
owned by the family of the candidate separately.
For eg. Plot 1: 150 Sq. yards., Plot 2:- 80 Sq.
Yards. etc.

(C) Address of residential plot(s)# owned by the |

family of the candidate
# Note:- Complete Address[village, Block, Tehsil,
District, State etc.] of all plot(s) owned by the
family of the candidate must be mentioned
separately. For eg. Plot 1:- ABC Colony, XYZ
State; Plot 2: PQR Colony, STU State etc.

7(A) Whether the family# of the candidate own | NO

residential plot(s) of 200 Sq. yards and above in
areas other than notified municipalities
# family for this purpose will include the person
who seek benefits of reservation, his/her parents,
and siblings below the age of 18 years as also
his/her spouse and children below the age of 18
years.

(B) Area of the residential plot(s)# owned by the |

family of the candidate in areas other than notified
municipalities
# Note:- If answer to para 7A is ‘Yes’: The
candidate must mention the area of all
residential plot(s) owned by the family of the
candidate in areas other than notified
municipalities separately. For eg. Plot 1: 150 Sq.
yards., Plot 2:- 80 Sq. Yards. etc.

(C) Address of residential plot(s)# owned by the |

family of the candidate in areas other than notified
municipalities
# Note:- Complete Address[village, Block, Tehsil,
District, State etc.] of all plot(s) owned by the
family of the candidate in areas other than
notified municipalities should be mentioned
separately. For eg. Plot 1:- ABC Colony, XYZ
State; Plot 2: PQR Colony, STU State etc.

8. Any other relevant information the candidate |

wish to submit relating to his/her EWS status

Roll No. :- 7905723 |

 Page No. 11/12

UNDERTAKING

I TANYA SHARMA son/daughter of Shri MADHAN MOHAN SHARMA Resident of village/town/city

FIROZABAD district FIROZABAD state UTTAR PRADESH Pin Code 283203 hereby declare that I
belong to Economically Weaker Section(EWS) Category . It is also declared that I have read and
understood the instructions mentioned in the Ministry of Social Justice & Empowerment’s O.M.
No.20013/01/2018-BC-II dated 17.01.2019, Department of Personnel & Training’s O.M.s
No.36039/1/2019-Estt.(Res.) dated 19.01.2019 and 31.01.2019 and I have reason to declare that I fall under
Economic Weaker Section(s) and eligible in all respects for getting reservation under EWS quota in direct
recruitment in civil posts and services in the Government of India.

DECLARATION OF EWS ANNEXURE

Information furnished above is true to the best of my knowledge and I have not concealed any relevant information. The
same information was submitted before the ‘Income and Asset Certificate’ issuing authority for getting this certificate and
availing myself of this benefit of reservation under EWS category. I swear that if it is found at any stage the information
furnished by me is false or that I have concealed some relevant information, I will forfeit the claim for appointment to any
service on the basis of Civil Services Examination 2019 and also be liable for all or any civil or criminal proceedings under
the law of the land.

Place: (Signature of the Candidate)

Date: Name of Candiate: TANYA SHARMA

Roll No. : 7905723

 Page No. 12/12
DECLARATION TO BE SIGNED BY THE CANDIDATE

I hereby declare that all statements and entries made in all the columns of this application are true, complete
and correct to the best of my knowledge and belief. I have read Rule 14, 23 and 24 of the Rules of the
Examination notified in the Gazette of India Extraordinary dated 19th February, 2019 and understand that 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/Government.

I further declare that I fulfil all the eligibility conditions regarding age limits, educational
qualifications etc. prescribed for admission to the Examination. I have not exhausted the number of
attempts admissible to me under the Rule 4 of the said rules of the Examination.

I have not withheld any information required as per this proforma.

I have read the rules and instructions carefully and I hereby undertake to abide by them.

I have informed my Head of the Office/Department in writing that I have applied for this
examination.

Place: (Signature of the Candidate)

Date:

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