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BHARATHIAR UNIVERSITY, COIMBATORE- 46

ANNA CENTENARY CIVIL SERVICES COACHING ACADEMY

I.A.S.,/I.P.S., PRELIMINARY EXAMINATION-2019

Application Form (Screening Test)

for the selection of candidates for full time free coaching

1. Name :

2. Date of Birth & Age :

3. Gender : Male / Female / Others

4. Marital Status : Married / Unmarried

5. Community :

6. Mobile No :

7. E-Mail Address :

8. Name of the Father / Mother :

9. Postal Address :

10. Resident Telephone No with STD code :

11. UPSC – Prelims previous attempts made if any :

Details :

12. Educational Qualifications (Give latest qualification first – UG/PG details only)

Education

Qualification

Class Year of

Passing

Subject(s)

Name of the College /

Institution

Name of the University

DECLARATION TO BE SIGNED BY THE CANDIDATE

I, hereby declare that all statements and entries made in columns of this application are true, complete

and correct to the best of my knowledge and belief. I promise 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 academy. I further declare that I fulfill all the eligibility conditions regarding age limits, educational

qualifications, Community Certificate etc., prescribed for admission to the Examination.

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

Place:

Date:

Signature of the candidate

Attachment:

Rs.5/- postal stamp affixed in Self Addressed postal cover with a one Passport size photo for

getting Hall Ticker (Compulsory)

(Office Use only)

App. No.________

___________

PHOTO

SC SC(A) ST BC BC(M) MBC DNT OC

)