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CONFIDENTIAL

PERSONAL INFORMATION QUESTIONNAIRE

107 - ADIPR Questionnaire No. 107- A (Revised)

O.I.R. .

Selection Board (No. & Place)

Batch No.

Chest No.

UPSC/ Other Roll No.

Name in CAPITALS (As in the matriculation certif icate) __________________________________________________________________

Fathers Name __________________________________________________________________

(a) Place of Maximum Residence (Place, District, State)

(with approximate population of the place) __________________________________________________________________

(b) Place of Present Residence (Place, District, State)

(with approximate population of the place) __________________________________________________________________

(c) Place of Permanent Residence (Place, District, State)

(with approximate population of the place)__________________________________________________________________

(Whether District HQ or not) __________________________________________________________________

Fill in the details below :-

(a) ? Parents Alive Yes/ No(b)

If not alive, your age at the time of Mother s / Fathers death __________________________________________________________________

(c) Parents /Guardians and Siblings Occupation / income (as applicable) :-

Educational Record (commencing from Matriculatio n/Equivalent Examination) :-

State & District

MarriedSingleWidower

Religion

Whether SC STOBC

Mother Tongue

Date of Birth

Particulars Education Occupation Income per month

CONFIDENTIAL

Father

Mother

Guardian

Elder Brother Sister

Elder Brother Sister

Younger Brother Sister

Younger Brother Sister

Qualificationacquired

Full Name ofInstitution

BoardUniversity

Year

Div.& Marks %

Medium of

Instruction

Boarder DayScholar

Outstandingachievement, if any

Matric Hr. Sec.

10+2 10+2 Equivalent

Graduation

Post-GraduationProfessional

http://localhost/var/www/apps/conversion/tmp/scratch_4/@O.I.Rhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Alivegka@ughahttp://localhost/var/www/apps/conversion/tmp/scratch_4/ekrk@firkhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ekrk&firk@lajhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ekrk&firk@lajhttp://localhost/var/www/apps/conversion/tmp/scratch_4/@vkhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Districtfookfgr@vfookfgrhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Married@Singlehttp://localhost/var/www/apps/conversion/tmp/scratch_4/Married@Singlehttp://localhost/var/www/apps/conversion/tmp/scratch_4/Married@Singlehttp://localhost/var/www/apps/conversion/tmp/scratch_4/Married@Singlehttp://localhost/var/www/apps/conversion/tmp/scratch_4/@Widowerhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ST@OBCekrhttp://localhost/var/www/apps/conversion/tmp/scratch_4/k@Particularsfhttp://localhost/var/www/apps/conversion/tmp/scratch_4/firk@Fatherhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ekrk@Motherhttp://localhost/var/www/apps/conversion/tmp/scratch_4/kd@Guardianhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/koklh@fnuhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Boarder@Dayhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Boarder@Dayhttp://localhost/var/www/apps/conversion/tmp/scratch_4/koklh@fnuhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Boarder@Dayhttp://localhost/var/www/apps/conversion/tmp/scratch_4/gks@Outstandinghttp://localhost/var/www/apps/conversion/tmp/scratch_4/d@gkhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Matric@Hrhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Matric@Hrhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Lukrd@Graduationhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Lukrd@Graduationhttp://localhost/var/www/apps/conversion/tmp/scratch_4/LukrdksRrj@Ohttp://localhost/var/www/apps/conversion/tmp/scratch_4/LukrdksRrj@Ohttp://localhost/var/www/apps/conversion/tmp/scratch_4/Lukrd@Graduationhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Matric@Hrhttp://localhost/var/www/apps/conversion/tmp/scratch_4/d@gkhttp://localhost/var/www/apps/conversion/tmp/scratch_4/gks@Outstandinghttp://localhost/var/www/apps/conversion/tmp/scratch_4/Boarder@Dayhttp://localhost/var/www/apps/conversion/tmp/scratch_4/koklh@fnuhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/HkkbZ@cguhttp://localhost/var/www/apps/conversion/tmp/scratch_4/kd@Guardianhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ekrk@Motherhttp://localhost/var/www/apps/conversion/tmp/scratch_4/firk@Fatherhttp://localhost/var/www/apps/conversion/tmp/scratch_4/k@Particularsfhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ST@OBCekrhttp://localhost/var/www/apps/conversion/tmp/scratch_4/@Widowerhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Married@Singlehttp://localhost/var/www/apps/conversion/tmp/scratch_4/Districtfookfgr@vfookfgrhttp://localhost/var/www/apps/conversion/tmp/scratch_4/@vkhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ekrk&firk@lajhttp://localhost/var/www/apps/conversion/tmp/scratch_4/ekrk@firkhttp://localhost/var/www/apps/conversion/tmp/scratch_4/Alivegka@ughahttp://localhost/var/www/apps/conversion/tmp/scratch_4/@O.I.R

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CONFIDENTIAL

/ Age ( Years & Months) / Height (in Metre) / Weight (in Kilogram)

______________________________________ _____________________________ __________________________________

Present Occupation and personal monthly income, if any ______________________________________________________________________________

(a) N.C.C. Training Yes/ No(b) If Yes, Total Training (Give details below)

(a) Participation in games & sports :-

(b) Hobbies / Interest ______________________________________________________________________________(c) Participation in extra-curricular, activities :-

(d) Position of responsiblity/offices held in NCC/Scouting ______________________________________________________________________________

Sports Team/Extra-curricular group and other fields ______________________________________________________________________________

(a) Nature of Commission(b) Choice of Service

Number of chances availed for commission in all three Services ______________________________________________________________________________

Details of all previous interviews, if any (Army NavyAir Force Selection Boards)

Total Training

Sl. No.

Type of Entry

GamesSports

Name of the activity group

Wing Division Certificate Obtained

Period or durationof Participation

RepresentedSchool / College / University / Other

Outstanding achievement, if any

Duration of Participation Outstanding achievement, if any

CONFIDENTIAL

SSB No. & Place

Date Chest No. Batch No.

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