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CONFIDENTIAL
Mhñ vkbZñ ihñ vkjñ iz’ukoyh la[;k 107 - A ¼la’kksf/kr½
Start filling only when told D IPR Questionnaire No. 107- A (Revised)
O;fDrxr tkudkjh iz ’ ukoyh
PERSONAL INFORMATION QUESTIONNAIRE vksñ vkbZñ vkjñ @ O.I.R. .
1- p;u cksM Z ¼la[ ;k vkSj L;ku½ cSp lañ pSL V la ñ ;wñ ihsñ ,lñ lhñ ;k vU; jksy uEcj
Selection Board (No. & Place) Batch No. Chest No. UPSC / Other Roll No.
1 AFSB DEHRADUN D-AFCAT(M)/109 31 IF ANY
2- lqLiI Vs v{kjks esa uke ¼tSl k eSfVªd izek.k&i= esa gS½
Name in CAPITALS (As in the matriculation certificate) RAMESH KUMAR
__________________________________________________________________
3- firk dk uke @ Father’s Name (Mr./Wg Cdr/Rank if any) Suresh Kumar
__________________________________________________________________
4- (a) vf/kdka’ k le; vkokl dk LFkku ¼LFkku] ftyk] jkT;½ ¼LFkku dh vuqe kfur tula[ ;k lfgr½
Place of Maximum Residence (Place, District, State)
(with approximate population of the place) Delhi,North Delhi,Delhi (20 million)
__________________________________________________________________
(b) orZe ku vkokl dk LFkku ¼LFkku] ftyk] jkT;½ ¼LFkku dh vuqe kfur tula[ ;k lfgr½
Place of Present Residence (Place, District, State)
(with approximate population of the place) Gorakhpur,Western UP,Uttar Pradesh (40 million)
__________________________________________________________________
(c) LFkkbZ vkokl dk LFkku ¼LFkku] ftyk] jkT;½ ¼LFkku dh vuqe kfur tula[ ;k lfgr½
Place of Permanent Residence (Place, District, State)
(with approximate population of the place) Delhi,North Delhi,Delhi (20 million)
__________________________________________________________________
¼og ftyk eq[ ;ky; gS vFok ugh½@ (Whether District HQ or not) Yes
__________________________________________________________________
5- fuEu fooj.k Hkjsa @ Fill in the details below :-
jkT; vkSj ftyk /keZ vuql wfpr tkfr@ tutkfr ;fn gS ekr` Hkkisk tUe frfFk fookfgr@vfookfgr@fo/kq j
State & District Religion Whether SC @ ST @ OBC Mother Tongue Date of Birth Married@ Single@ Widower
Delhi,North Delhi Hindu NO Hindi 23/04/1991 Single
6- (a) D;k ekrk&firk ftfor gS a ? @ Parents Alive Yes gka@ ugha @ Yes / No
Tick accordingly
(b) ;fn ftfor ugha rks ekrk@ firk dh e`R;q ds le; vkidh vk;q
If not alive, your age at the time of Mother’ s / Father’s death -n/a-
__________________________________________________________________
(c) ekrk&firk@laj {kd vkSj HkkbZ&cgu ds O;olk;@vk; ¼tks ykxw gks½ @ Parents’ / Guardian’s and Siblings’ Occupatio n/ income (as applicable) :-
fooj.k @ Particulars f’k{kk@ Education O;olk;@ Occupation ekfld vk;@ Income per month
firk@ Father B.A Business Rs.70,000/-
ekrk@ Mother B.Com Service Rs.50,000/
laj {kd@ Guardian -
cM+k HkkbZ@ cgu@ Elder Brother @ Sister Bsc Final Year Student -n/a-
cM+k HkkbZ@ cgu@ Elder Brother @ Sister
NksV k HkkbZ@ cgu@ Younger Brother @ Sister 7th Standard Student -n/a-
NksV k HkkbZ@ cgu@ Younger Brother @ Sister
7- ’kSf{kd fjdkMZ ¼eSfVª dq ys’ ku@lEd{k ifj{kk ls vkjEHk djds½ @ Educational Record (commencing from Matriculatio n / Equivalent Examination) :-
izk Ir ;ks x ;rk,s a laL Fkku dk iwjk uke cks M Z @ ;q f uoflZ V h oi s Z Js.kh o vad f’k{kk dk ek/;e Nk=koklh@fnu Nk= vlk/kkj.k mIyfC/k] ;fn
Qualification Full Name of Board@ Year iz f r’kr@ Div. Medium of Boarder @ Day dksb Z gks@ Outstanding
acquired Institution University & Marks % Instruction Scholar achievement, if any
eS f Vª d @ gk;j lSd sa M jh RP Public 2007 FIRST, English Day Bronze Medal, Swimming
CBSE Nationals(2006)
Matric @ Hr. Sec.
School,New Delhi 75% Scholar
RP Public FIRST, English 1st Position,PERC
10+2 ds le{k
10+2 Equivalent
School,New Delhi CBSE 2009 80% Day Scholar Debate,Kanpur
Lukrd@ Graduation 79% till 7th 2nd Position,IEEE
BTech,Rohilkhand University, Rohilkhand 2009- English Boarder
Semester Conference(2012),
Gorakhpur University 2013
Pune
Lukrdks R rj @ O;olkf;d
Post-Graduation @
Professional
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8- vk;q ¼oiZs vkSj ekg½ / Age ( Years & Months) mpkabZ ¼ehVj esa½ / Height (in Metre) otu ¼fdyksxzke esa½ / Weight (in Kilogram)
22 years,3 months
______________________________________ 1.6m
_____________________________ 57kgs
__________________________________
9- orZe ku O;olk; vkSj O;fDrxr ekfld vk;] ;fn gS
Present Occupation and personal monthly income, if any
Student
______________________________________________________________________________
10- (a) jkI Vªs h; dSfMV dksj izf’k{k.k @ N.C.C. Training NO gka@ ugha @ Yes / No
(b) ;fn gkWa] rks dq y izf’k{k.k ¼fooj.k uhps nks½ @ If Yes, Total Training (Give details below)
dq y izf’k{k.k @ Total Training Lda/ k @ Wing iz H kkx @ Division izkIr ize k.k i= @ Certificate Obtained
11- (a) [ksydwnksa esa Hkkxhnkjh @ Participation in games & sports :-
[ksy @ dz hM+k dk uke Hkkx ysus dh vof/k@ Period or duration Ldw y @dkys t @fo’ofo}ky;@vU; tgk a W vlk/kkj.k fuI ifr]
s ;fn dksb Z gks
Games @ Sports of Participation dk izfrfuf/kRo fd;k @ Represented Outstanding achievement, if any
School / College / University / Other
SWIMMING 2006 RP PUBLIC SCHOOL, BRONZE
NEW DELHI
CHESS 2008-2013 CASUAL
(b) ’kksd@#fp;ka @ Hobbies / Interest READING,WRITING,PAINTING,TRAVELLING
______________________________________________________________________________
(c) ikB~; fois ;srj lkewfgd dk;Zdykiksa esa Hkkxhnkjh@ Participation in extra-curricular, activities :-
dk;Zd yki lewg dk uke Hkkx ysu s dh vof/k @ Duration of Participation vlk/kkj.k fuI ifr]
s ;fn dksb Z gks
Name of the activity group Outstanding achievement, if any
PERC DEBATE,KANPUR 2008 FIRST
IEEE CONFERENCE,PUNE 2012 SECOND
(d) jkI Vªs h; dSM sV dksj @ LdkmfVax @ [ksy dw n@ ikB~; sRrj vkSj vU; {ks= ksa esa mRrjnkf;Ro dk in
Position of responsiblity/offices held in NCC/Scouting
Sports Team/Extra-curricular group and other fields
HEAD BOY OF SCHOOL(2008-2009)
______________________________________________________________________________
______________________________________________________________________________
12- (a) deh’ku dk Lo#i @ Nature of Commission SHORT SERVICE/PERMANENT COMMISSION
(b) lsok dk p;u @ Choice of Service INDIAN AIR FORCE
1 3 - rhu lsokvksa esa deh’ku ds fy, fdrus ekSds ys pqds gSa &
02
Number of chances availed for commission in all three Services ______________________________________________________________________________
1 4 - fiNys lHkh lk{kkRdkjksa dk fooj.k] ;fn dksb Z gks ¼vkehZ @ uso h @ ,;j Qksl Z p;u cksM Z½ Dont't act smart & hide your
Details of all previous interviews, if any (Army @ Navy@ Air Force Selection Boards)
details
dz e la ñ ios’ k dk izd kj ftlds fy, cSB s ,l ñ ,l ñ ch ñ uañ vkSj LFkku rkjh[k @ Date pSLV vkSj cSp uañ
@ Sl. No. Type of Entry SSB No. & Place Chest No. @ Batch No.
1. NDA 18-SSB,ALLAHBAD 24/08/2009 12/B-ARMY(119)
12/01/2013 56/B-NSB(099)
2. UES NAVY 33 SSB,BHOPAL
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