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Preview

  Personal Information

Note/Instructions:
1. Name as recorded in the matriculation/secondary examination marksheet.
2. Name (Candidate’s/Father’s/Mother’s Name) given in the application and all the uploaded documents i.e. ID
Card, educational certificates, category certificate (SC/ST/OBC/EWS) or any other uploaded document
should be same or else the candidature will be cancelled.
3. E-mail ID and mobile number once entered can’t be changed during the entire recruitment process.
4. Candidate is to bring same ID card (provided here) in original at all stages of recruitment.
5. Two different permanent identification marks on the body such as birthmark, mole and burn/injury mark are
to be entered as text.
6. Candidate to upload class 10th marksheet/certificate with date of birth mentioned as date of birth proof or
else Birth certificate to be uploaded.
7. Candidate is to scan the original documents (neither photocopy nor self-attested photocopy) to upload in
the online application.
8. Scanned document should be saved in .jpeg / .jpg format and size should be between 50KB to 150KB.
9. All the uploaded documents must be in Hindi or English. If, the document is in any language other than
English or Hindi then candidate is to upload both original and English translation of document as one
file/document (after merging both documents) in the online application.
10. Click here for specimen of document.

NAME Mr. Vishal Raghav NAME AS Vishal Raghav FATHER'S Yudhishthar

ON ID NAME
CARD
Singh

MOTHER'S Sangeeta EMAIL ID thakursahab3456878 MOBILE 917248817280

NAME
Kumari @gmail.com
NATIONALI Indian MARITAL Unmarried GENDER Male
TY STATUS

DO YOU Yes ID CARD Aadhaar Card ID CARD XXXXXXXX091

HAVE NUMBER
AADHAAR
3
CARD?

PERMANEN A Mol On Right Hand PERMANEN A Mol On Left Hand CATEGORY Unreserved
T T
IDENTIFICA IDENTIFICA
(General)
TION MARK TION MARK
1 ON THE 2 ON THE
BODY BODY

DATE OF 25-May-2006 DATE OF 10th Class AGE No

BIRTH BIRTH RELAXATIO
PROOF
Marksheet/Cer N
TYPE tificate

FEE No EMPLOYME Unemployed GOT Youtube

WAVIER NT TYPE INFORMATI
CLAIMED ON ABOUT
INDIAN
COAST
GUARD
RECRUITM
ENT

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ID Proof (Aadhaar Card) Date of Birth Proof (10th Class

Marksheet/Certificate)

  Post Selection

POST APPLIED Navik(GD)

  Class 10th Details

Note/Instructions:
1. 10th marksheet and certificate need to be uploaded at Stage-II.
2. In case of CGPA or Grade, conversion formula document need to be uploaded at Stage-II.
3. If you have additional certificate, the document of the same need to be uploaded at Stage-II.

EDUCATIO U.P. Board of GRADING Percentage DO YOU No

N BOARD SYSTEM AS HAVE
High School & INDICATED ADDITIONA
Intermediate IN L
Education MARKSHEE MARKSHEE
T T

10TH 25012286 YEAR OF 2022 NO. OF 6

CERTIFICAT PASSING SUBJECTS
E NUMBER IN CLASS
10TH

Subject HINDI ENGLISH MATHEMATICS SCIENCE Social Sciences DRAWING

Marks Obtained 88 76 90 73 77 90

Total Marks 100 100 100 100 100 100

  Class 12th Details

Note/Instructions:
1. 12th marksheet and certificate need to be uploaded at Stage-II.
2. In case of CGPA or Grade, conversion formula document need to be uploaded at Stage-II.
3. If you have additional certificate, the document of the same need to be uploaded at Stage-II.

EDUCATIO U.P. Board of GRADING Percentage DO YOU No

N BOARD SYSTEM HAVE
High School & INDICATED ADDITIONA
Intermediate IN L
Education MARKSHEE MARKSHEE
T T

12TH 25011290 YEAR OF 2024 NO. OF 5

CERTIFICAT PASSING SUBJECTS
E NUMBER IN CLASS
12TH

Subject Physics Mathematics GENERAL HINDI ENGLISH CHEMISTRY

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Marks Obtained 54 44 91 70 60

Total Marks 100 100 100 100 100

  Additional Details

1) HAVE YOU BEEN DISCHARGED FROM THE INDIAN ARMY / INDIAN NAVY / INDIAN AIR FORCE OR ANY GOVERNMENT ORGANIZATION ?

No
2) HAS ANY WARRANT OR SUMMONS FOR YOUR APPEARANCE AS WITNESS BEEN ISSUED AND PENDING BEFORE A COURT OF LAW FOR THE TIME
BEING IN FORCE ?

No
3) ARE ANY PROCEEDINGS IN RESPECT OF AN OFFENCE ALLEGED TO HAVE BEEN COMMITTED BY YOU PENDING BEFORE A CRIMINAL COURT IN
INDIA ?

No

4) HAS ANY WARRANT OR SUMMONS FOR YOUR OFFENCE BEEN ISSUED AND PENDING BEFORE A COURT OF LAW FOR THE TIME BEING IN FORCE ?

No

5) HAS A WARRANT FOR YOUR ARREST BEEN ISSUED BY A COURT UNDER ANY LAW FOR THE TIME BEING IN FORCE ?

No
6) HAVE YOU, AT ANY TIME PRECEDING THE DATE OF THIS APPLICATION, BEEN CONVICTED BY A COURT OF INDIA FOR ANY OFFENCE AND
SENTENCED IN RESPECT THEREOF TO IMPRISONMENT ?

No

7) HAVE YOU APPLIED IN HIGHER COURT FOR ACQUITTAL AGAINST THE CONVICTION OF LOWER COURT ?

No
8) HAVE YOU EVER BEEN DEBARRED BY ICG / ARMY / NAVY / AIR FORCE / UPSC / CENTRAL OR STATE GOVT. DURING ANY RECRUITMENT
PROCESS ?

No

  Communication Details

Permanent Address
HOUSE/ST VILLAGE BEHTA LANDMARK NEAR HOLI CHOK POST BAHJOI
REET OFFICE
JAISINGH BEHTA JAISINGH
COUNTRY India STATE/ UT Uttar Pradesh DISTRICT Sambhal
SUB Chandausi PIN CODE 244410 PHONE NO N.A
DISTRICT WITH AREA
CODE

Present/Current Address
HOUSE/ST VILLAGE BEHTA LANDMARK NEAR HOLI CHOK POST BAHJOI
REET OFFICE
JAISINGH BEHTA JAISINGH
COUNTRY India STATE/ UT Uttar Pradesh DISTRICT Sambhal
SUB Chandausi PIN CODE 244410 PHONE NO N.A
DISTRICT WITH AREA
CODE

Domicile Details

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DOMICILE UTTAR RECRUITM North Zone DOMICILE Sambhal
STATE ENT DISTRICT
PRADESH REGION

DOMICILE 755242014257 DATE OF 16-Jun-2024 DOMICILE CERTIFICATE

CERTIFICAT ISSUE OF
E NUMBER DOMICILE
CERTIFICAT
E

  Photo and Signature

Note/Instructions:
1. Click here for specimen of photograph.
2. While uploading Photo / Signature , file nomenclature should be as follows:
Passport photograph: Passport_Photograph
Scanned signature image: Signature
3. Any discrepancy or anomaly in clarity of images of uploaded documents in the online application will lead
to cancellation of candidature.

PHOTO LIVE PHOTO SIGNATURE

  Stage - I - Exam City Preferences

Note/Instructions:
1. Your 5 preferences nearest to present address in increasing order of distance.
2. Non-compliance to this instruction may lead to cancellation of your candidature during document
verification.

1. Meerut 2. Bareilly 3. Lucknow 4. Prayagraj 5. Varanasi

  Uploaded Documents

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ID PROOF (AADHAAR CARD)

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DATE OF BIRTH PROOF (10TH CLASS MARKSHEET/CERTIFICATE)

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DOMICILE CERTIFICATE

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COMMON REASONS FOR REJECTION DURING DOCUMENT

VERIFICATION

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COMMON REASONS FOR REJECTION DURING DOCUMENT

VERIFICATION

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COMMON REASONS FOR REJECTION DURING DOCUMENT

VERIFICATION

 Declaration

CITY * BAHJOI DATE * 15-06-2025

Enter city properly

I hereby declare that all the above information provided by me is correct.

I owe allegiance to the sovereignty, unity and integrity of India. I have not lost, surrendered or been
deprived of the citizenship of India.

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I am eligible to apply for the said rank category as per the Indian Coast Guard (ICG) advertisement for
present batch and have also read the FAQs and common reasons for rejection during various stages of
recruitment given on website.
I declare that I have applied for only one post viz. either Navik (DB) or Navik (GD) or Yantrik (Mechanical)
or Yantrik (Electrical) or Yantrik (Electronics) in present cycle. I understand that if, multiple applications
are filled by me, then ,only the latest filled application will be accepted and all the other applications
will be rejected and the exam fee paid against these applications will not be refunded.
I declare to remember my mobile number and E-mail ID used during filling of online application, as, the
primary mode of communication of ICG with me will be either through ICG website or E-mail.
I understand that Coast Guard will be uploading E-admit card, result of various stages of recruitment in
my login dashboard and will also be publishing various updates/announcements regarding
recruitment on Coast Guard recruitment website. Hence, I declare to visit ICG website and my login
dashboard on regular/daily basis. ICG will not be responsible if I fail to visit ICG website on a daily basis
and comply with the instructions therein given from time to time and will not claim re-examination.
I understand that capturing and verification of biometric impression is mandatory for appearing at all
stages of recruitment.
I understand that Indian Coast Guard reserves the right to conduct assessment/adaptability of
candidates at any stage of the recruitment process, prior issue of appointment letter to avoid
impersonation. I understand that my candidature can be cancelled on account of impersonation and
the decision of Indian Coast Guard will be final and binding on me in this regard.
I understand that my candidature will be cancelled and I will be debarred from future Coast Guard
Recruitment examinations in case I am found to be involved in malpractice during any stage of current
recruitment process.
I affirm that the information and particulars given by me in this application are true/correct and I am not
suppressing any material information in this regard. I further affirm that the certificates (ID Proof/DOB
proof/NOC/Domicile certificate) uploaded in support of my application for recruitment of the said post
are authentic and solely pertain to me and I am fully responsible for the accuracy of the same.
I declare that my SC/ST/OBC (non-creamy layer)/EWS certificate comply with the instructions given in
the advertisement regarding the format of certificate for appointment to the post under Government of
India. If my candidature is cancelled on account of incorrect category document then I shall not be
considered against unreserved vacancy as I have submitted false information.
I certify that I am in possession of originals of all the documents uploaded in the online application.
Failure to present the original document as uploaded in online application on account of loss of
documents will lead to cancellation of candidature. I understand that no request in this regard will be
entertained by ICG even if I produce an F.I.R. w.r.t. theft of my documents and my candidature will stand
cancelled.
I declare that the form is filled by myself and not any other person, and for any mismatch/wrong
information/incorrect photo/signature/thumb image uploads, I will be responsible. I am aware that,
my candidature can be cancelled, in case of any mismatch/wrong information.
I have completely checked the print preview of the application and I certify that my application is
correct in all aspects as per the advertisement.
NO CLAIM / RISK UNDERTAKING:- I am a candidate for recruitment in Indian Coast Guard. I give my full
and free consent at my own risk that I shall not be entitled to claim any compensation or other relief
from the government in respect of any injury or disability which I may sustain in the course of or as the
result of any of the tests (both physical fitness test and medical test) administrated to me or attended
by me during the recruitment procedure, whether due to my own negligence or any other person or
otherwise.
If the candidate fills multiple applications in one particular cycle,then his latest filled application will be
accepted and all previously filled application will be rejected.

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