ANNEXURE TO APPLICATION FORM

PROFORMA TO BE FILLED BY OBC CANDIDATES

1.

Name of candidate

2.

Roll No.

3.

(a) Name of Father

___________________________________________

(b) Date of birth of Father

___________________________________________

(a) Name of Mother

___________________________________________

(b) Date of birth of Mother

___________________________________________

(a) Profession of Father

___________________________________________

(b) (i) If in service, whether he is/was working under

Central Govt./State Govt./Public Sector
Undertaking/Autonomous Body/Private
Organisation or somewhere else.

___________________________________________

4.

5.

___________________________________________

(ii) Name of the post to which he was appointed

by direct recruitment.

(iii) Group of the post (viz. Group A, B, C or D) to

which he was appointed by direct recruitment.

(iv) If posts in the organization are not classified as

Group A, B, C or D, whether the post to which
the father was appointed by direct recruitment is
comparable or equivalent to any group A, B, C or
D post in Govt. If yes, to which it is comparable.

____________________________________________

____________________________________________

____________________________________________

(v) Details of all the post held by Father

Name of the post and group of

the post & equivalent of post

Pay Scale of the post

(vi) Whether the father has/had been in employment

in any International Organisation like U.N., IMF,
World Bank. If yes, duration of such employment.

(vii) If father is dead, date of his demise.

Date of Appointment/
Promotion to the post

Age at the time of

appointment/promotion

____________________________________________

____________________________________________

(viii) If father suffer from permanent incapacitation,

Date from which he so suffers.

____________________________________________

6. (a) Whether father of the candidate holds or has ever

held a Constitutional post.

____________________________________________

(b) If yes, name of the post(s) and duration of holding

the post(s).

____________________________________________

7.

If father is/was in armed forces or in para military service, ____________________________________________

the post which he is/was holding or held at the time of
retirement/leaving the job.

8.

(a) Profession of Mother

___________________________________________

(b) (i) If in service, whether she is/was working under

Central Govt./State Govt./Public Sector
Undertaking/Autonomous Body/Private
Organisation or Somewhere else.

___________________________________________

(ii) Name of the post to which she was appointed

by direct recruitment.

(iii) Group of the post (viz. Group A, B, C or D) to

which she was appointed by direct recruitment.

(iv) If posts in the organization are not classified as

Group A, B, C or D, whether the post to which
the mother was appointed by direct recruitment is
comparable or equivalent to any group A, B, C or
D post in Govt. If yes, to which it is comparable.

____________________________________________

____________________________________________

____________________________________________

(v) Details of all the post held by Mother :-

Name of the post and group of

the post & equivalent of post

Pay Scale of the post

(vi) Whether the mother has/had been in employment

in any International Organisation like U.N., IMF,
World Bank. If yes, duration of such employment.

(vii) If mother is dead, date of her demise.

Date of Appointment/
Promotion to the post

Age at the time of

appointment/promotion

____________________________________________

____________________________________________

(viii) If mother suffer from permanent incapacitation,

date from which she so suffers.

9. (a) Whether mother of the candidate holds or has ever

held a Constitutional post.

(b) If yes, name of the post(s) and duration of holding

the post(s).

____________________________________________

____________________________________________

____________________________________________

10. If mother is/was in armed forces or in para military service,

the post which she is/was holding or held at the time of
retirement/leaving the job.

____________________________________

11. (A) Whether the parents of the candidate own agricultural land.

____________________________________

(B)) If Yes,

(a) Area of the irrigated land owned by father, mother and

Children put together.

____________________________________

(b) Area of the unirrigated land owned by father, mother and

Children put together.

____________________________________

(c) Statutory ceiling limit of land hold at the place where

land owned is located.

____________________________________

(d) If the land is both irrigated and unirrigated, indicate

whether condition given in clause (b)(i) of Schedule V
to the DoP&T O.M. No.36012/22/93-Estt.(CST), dated
8-9-1993 applies. Give detailed.

____________________________________

____________________________________

12. Annual income of father for last three years (year-wise)

(a) Income from salary

____________________________________

(b) Income from agriculture

____________________________________

(c) Income from other sources

____________________________________

(Note : Attach income-tax returns)

13. Annual income of mother for last three years (year-wise)

(a) Income from salary

____________________________________

(b) Income from agriculture

____________________________________

(c) Income from other sources

____________________________________

(Note : Attach income-tax returns)

14. (a) Details of wealth held by parents

(b) Whether the wealth held is within the exemption limit

as prescribed in Wealth Tax Act ?

15. Whether documentary proof in support of service/status/

land holding /income from different sources property held by
parents have been attached ?

____________________________________

____________________________________

____________________________________

Information furnished above is true to the best of my knowledge and I have not concealed any relevant information. I
swear that if it is found at any stage that information furnished by me is false or that I have concealed some relevant information,
I will forfeit the claim to appointment to any service on the basis of Engineering Services Examination, 2013.

Signature of the Candidate

Place

Date .