CONFIDENTIAL
DIPR Questionnaire No. 107-A (Revised)
PERSONAL INFORMATION QUESTIONNAIRE
O.I.R._______________
1. Selection Board (No. & Place) Batch No. Chest No. UPSC/Other Roll No.
2. Name in capital (As in the application form) _______________________________________
3. Father Name _______________________________________
4. (a) Place of Maximum Residence (Place, District, State) _________________________________
(b) Place of Present Residence (Place, District, State) _________________________________
(c) Place of Permanent Residence (Place, District, State) _________________________________
(Whether District HQ or not) _________________________________
5. Fill in the details below :-
State & District Religion Whether Mother Date of Birth Marries/Single/W
SC/ST Tongue idower
6. (a) Parents alive Yes/No.
(b) If not alive, your age at the time of father/mother’s death _____________________________
(c) Parents/Guardian Occupation/Income (as applicable)
Particulars Education Occupation Income per Month
Father
Mother
Guardian
Elder Brother/Sister
Elder Brother/Sister
Young Brother/Sister
Young Brother/Sister
7. Educational Record (commencing from Matriculation/Equivalent Examination):-
Qualification Name Of Board/ Year Division & Medium Of Boarder/ Outstanding
Acquired Institution University Marks% Instruction Day Achievement
Scholar if any
Metric/Hr. Sec.
10+2 equivalent
Graduation
Post Graduation
/ Professional
8. Age (Year & Months) Height (In Metre) Weight (In Kilogram)
______________________ ________________________ ________________________
9. Present Occupation and Personal monthly income. If any _________________________________
10. (a) N.C.C. Training Yes /No
(b) If Yes, Total Training (Give details below)
Total Training Wing Division Certificate Obtained
11. (a) Participation in Games & Sports :-
Game/Sports Period of duration of Represented School/ Outstanding
Participation College/ University achievement if any
(b) Hobbies / Interest _________________________________
(c) Participation in extra-curricular, activities :-
Name of the activity group Duration of Participation Outstanding achievement if any
(d) Position of responsibility/ offices held in NCC / Scouting/ ______________________________
Sport team / Extra-curricular Group and other fields ______________________________
12. (a) Nature of Commission
(b) Choice of Service
13. Number of chances availed for commission in all three Services ___________________________
14. Details of previous interviews, if any (Army/ Navy/ Air Force Selection Boards)
St. No. Type of Entry SSB No. & Date Chest Recommended/
Place No/Batch No. Not
Recommended
15. Metric/ Higher Secondary
Name of Institution (In full, no abbreviations) _________________________________________
Location of Institution(City/Town/Village) Name of Board
__________________________________ (CBSE/ICSE/State Board/Others) ______________
Type of Institution Govt./Private Medium of Instruction
Hindi/English/Regional _______________
Year of Passing__ Overall Percentage of Marks obtained_____ Division____ Day scholar/Boarder
Subject Theory Practicals/ Sessionals Total Outstanding
Achievements
(if any)
Max Marks % Max Marks % Max Marks %
Marks obtained Marks obtained Marks obtained
Total
16. Senior Secondary / 10+2 / Equivalent
Name of Institution (In full, no abbreviations) _________________________________________
Location of Institution(City/Town/Village) Name of Board
__________________________________ (CBSE/ICSE/State Board/Others) ______________
Type of Institution Govt./Private Medium of Instruction
Hindi/English/Regional _______________
Year of Passing__ Overall Percentage of Marks obtained_____ Division____ Day scholar/Boarder
Subject Theory Practicals/ Sessionals Total Outstanding
Achievements
(if any)
Max Marks % Max Marks % Max Marks %
Marks obtained Marks obtained Marks obtained
Total
17. Graduation
Name of Institution (In full, no abbreviations) _________________________________________
Location of Institution(City/Town/Village) ________________________________________
University ______________________________________________________________________
Course B Tech/ B E / B Sc / B.com / B A Branch / Stream
__________________________
Year of Admission _______Pursuing/Completed Year of completion _______ Day scholar/Boarder
Medium of Instruction Hindi/English/Regional __________ Division____ Aggregate percentage___
Year/ Theory Practicals/ Sessionals Total Outstanding
Semester Achievements
(if any)
Max Marks % Max Marks % Max Marks %
Mark obtained Marks obtained Marks obtained
s
1
2
3
4
5
6
7
8
Total
18. Post Graduation
Name of Institution (In full, no abbreviations) _________________________________________
Location of Institution(City/Town/Village) ________________________________________
University ______________________________________________________________________
Course B Tech/ B E / B Sc / B.com / B A Branch / Stream __________________________
Year of Admission _______Pursuing/Completed Year of completion _______ Day scholar/Boarder
Medium of Instruction Hindi/English/Regional __________ Division____ Aggregate percentage___
Year/ Theory Practicals/ Sessionals Total Outstanding
Semester Achievements
(if any)
Max Marks % Max Marks % Max Marks %
Marks obtained Marks obtained Marks obtained
1
2
3
4
5
6
7
8
Total
