Page No.

1/17

UNION PUBLIC SERVICE COMMISSION

DETAILED APPLICATION FORM
CIVIL SERVICES EXAMINATION, 2025

RID. : 12510481134
Name : MOHD ZEESHAN
Have you ever changed your name? : NO
Email : ibrahimzeeshan8@[Link]
Mobile : 8123289837

1. (a) Date of Birth | 10-03-1995

(b) Age Relaxation claimed | YES
(c) Nature of Age relaxation claimed |2
(If yes, upload a scanned documentary proof/ documentary evidence in support of your claim)

2. (a) Address for correspondence to which | 2-4-511 BAWARCHI GALLI

Communication is to be sent |
Post Office: | BIDAR
City: | BIDAR
District: | BIDAR
State : | KARNATAKA
Pin Code : | 585401
(b) Telephone No. (with STD Code) | -
(c) Mobile No. | 8123289837
(c.1) Alternate Mobile No. |
(d) Fax No. |
(e) E-mail address | IBRAHIMZEESHAN8@[Link]
(f) Permanent Postal Address | 2-4-511 BHAWARCHI GALLI
|
Post Office: | BIDAR
City: | BIDAR
District: | BIDAR
State : | KARNATAKA
Pin Code : | 585401

3. Gender : | MALE

4. Marital Status : | UNMARRIED

(If Married, Nationality of spouse) |
5. (a) Citizenship : | A CITIZEN OF INDIA.(1)
(b) Nationality : | INDIAN

6. Mother tongue : | URDU

7. Place of Birth :

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If born in India: | YES
Post Office | BIDAR
City/Town/Village | BIDAR
District | BIDAR
State | KARNATAKA
Pincode | 585401

8. (a) Community | OBC (3)

Note 1: No change in the community status already indicated by candidate in his / her application form for
this examination will be allowed by the Commission except in the circumstances mentioned in the
Rule 26 of CSE Rules, 2025.
Note 2: In case you are a SC or ST category candidate, upload a scanned copy of certificate in prescribed format
in support of your claim. The certificate must be issued latest by the date of closure of online application
form for Civil Services (Preliminary) Examination, 2025.
Note 3: In case you are EWS Category candidate, upload a scanned copy of ‘Income and Asset Certificate’ in
prescribed format based on the income for Financial Year 2023-24 (i.e. for the period from 1st April, 2023
to 31st March, 2024) in support of your claim. Certificate based on the income of any other Financial
Year shall not be treated as valid. The Certificate must be issued on/after 01.04.2024 (after the completion
of FY 2023-24) but not later than the closing date of the application for Civil Services (Preliminary)
Examination-2025. Such candidates must meet the Income and Asset criteria issued by the
Central Government.
Note 4: In case you are an OBC Category candidate, upload a scanned copy of OBC (Non-Creamy Layer)
certificate inprescribed format based on the income for the Financial Years (FYs) 2023-24, 2022-23
and [Link] Certificate must be issued on/after 01.04.2024 (after the completion of FY 2023-24) but
not later than the closing date of the application for Civil Services (Preliminary) Examination-2025

(b) Certificate No. | RD1218138030089

(c) Date of issue | 2024-07-29
(d) Designation of issuing authority | TALUKA MAGISTRATE
(e) Full address of issuing authority | CMC BIDAR CHOUBARA VILLAGE [Link] BIDAR

(f) Name of the Caste as mentioned in | MUSLIM (MUSLIM)

the Community Certificate and | KARNATAKA
Name of the issuing State.
[For SC/ST/OBC Candidates]
(g) State Creamy or Non Creamy Layer | Non Creamy Layer
(h) If you belong to any of the minority
Communities notified by the Government
(Muslim/Christians/Sikhs/Buddhists/
Zoroastrians[Parsi]/Jains) | YES
(i) If yes, Name of the Minority
community | MUSLIM

9.1.(a) Whether you are a PwBD/PwD | NO

candidate
(b)(1) Category |

(b).2 Indicate Form Type of the Certificate |

of Disability
(c) Percentage of disability as indicated in |
the Certificate of Disability

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(d) Certificate No. |
(e) Date of Issue |
(f) Designation of issuing authority |
(g) Full address of issuing authority |

(h) Are you a PwBD/PwD candidate [as |

per column 9.1.(a)] having physical
limitation to write?(If Yes, upload
scanned copy of the requisite certificate
as per Appendix-V (for PwBD) /
Appendix-VII (for PwD)of the Notice
of CSE, 2025 dated 22nd January,
2025)

(i) Do you want to avail Compensatory |

Time
(j) Would you require scribe in the |
Examination
Note 1: The Persons with Benchmark Disabilities(PwBD)in the categories of blindness, locomotor disability (both
arm affected – BA) and cerebral palsy will be eligible for the facility of scribe. In case of other
category of Persons with Benchmark Disabilities as defined under section 2(r) of the RPWD Act, 2016,
such candidates will be eligible for the facility of scribe on production of a certificate to the
effect that the person concerned has physical limitation to write, and scribe is essential to write
examination on behalf, from the Chief Medical Officer/ Civil Surgeon/ Medical Superintendent of a
Government Health Care institution as per proforma at Appendix-V of the Notice of CSE, 2025 dated,
22nd January, 2025.
Further, for persons with specified disabilities (PwD) covered under the definition of Section 2(s) of the
RPwD Act, 2016 but not covered under the definition of Section 2(r) of the said Act, i.e. persons having
less than 40% disability and having difficulty in writing will be eligible for the facility of scribe
subject to production of a certificate from the competent medical authority of a Government healthcare
institution as per proforma at Appendix-VII of the Notice of CSE-2025 dated 22nd January, 2025 to
the effect that person concerned has limitation to write and that scribe is essential to write examination
on his/her behalf.
Facility of Scribe to eligible candidates will be provided, if desired by them.
Note 2: The candidates have discretion of opting for their own scribe or request the Commission for the same.
Note 3: The qualification of the Commission’s scribe as well as own scribe will not be more than the minimum
qualification criteria of the examination. However, the qualification of the scribe should always be
matriculate or above.
Note 4: The Persons with Benchmark Disabilities(PwBD) in the category of blindness, locomotor disability (both
arm affected – BA) and cerebral palsy will be eligible for Compensatory Time of twenty minutes per hour
of the examination. In case of other categories of Persons with Benchmark Disabilities, such candidates
will be eligible for this facility on production of a certificate to the effect that the person concerned
has physical limitation to write from the Chief Medical Officer/ Civil Surgeon/ Medical Superintendent
of a Government Health Care institution as per proforma at Appendix – V of the Notice of CSE, 2025
dated 22nd January, 2025.
Further, for persons with specified disabilities(PwD) covered under the definition of Section 2(s) of the
RPwD Act, 2016 but not covered under the definition of Section 2(r) of the said Act, i.e. persons having
less than 40% disability and having difficulty in writing will be eligible for compensatory time subject
to production of a certificate to the effect that person concerned has limitation to write from the
competent medical authority of a Government healthcare institution as per proforma at Appendix-VII of
the Notice of CSE-2025 dated 22nd January, 2025.

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Facility of Compensatory time to eligible candidates will be provided, if desired by them.
(j)(i) If yes, "Commission's Scribe" or "Own |
Scribe"
(k) Would you require any assistive |
device(s)
(l) Would you require question paper in |
larger font size?

Note: Larger font is only for PwBD Candidates suffering from Blindness/ Low Vision.
9. 2. (a) Have you ever been recommended as a | NO
PwBD candidate in the examinations
conducted by the UPSC in the past?

(b). If yes, mention name and year of the examination(s) with Roll No.
Name of the Examination Year of the Roll No.
Examination

(c) Whether such recommendation was on | NO

the basis of the Certificate of Disability
NOW UPLOADED by you for the
CSE, 2025?
(d) After any such recommendation by the | NO
UPSC were you ever found UNFIT/
NOT RECOMMENDED by the Central
Standing Medical Board or any other
Medical Board constituted by the
Government with regard to your
physical disability?
(e) If yes, provide details thereof |

10. Choice of Centre for Examination | HYDERABAD

11.
(a)(i) Do you hail from Arunachal Pradesh/
Manipur/Meghalaya/Mizoram/Nagaland/
Sikkim and are claiming exemption
from appearing in INDIAN LANGUAGE
FOR PAPER A? | NO

(ii) Are you a PwBD candidate falling

under Deaf/Hard of Hearing category
and seeking exemption from appearing
in INDIAN LANGUAGE FOR PAPER A? | NO
(iii)Indian Language for Paper A | HINDI
(b) Optional Subject for paper VI & VII | POLITICAL SCIENCE & INTERNATIONAL
RELATIONS

12. (a)Language Medium for Examination

for Paper I to Paper V
(Essay and General Studies) | ENGLISH

(b) Language Medium for Examination

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for Paper VI to Paper VII (Optional
Subject as at (b) of Col. 11 above) | ENGLISH

(c) In case of Sindhi and Santhali,

type of script should be indicated
by the candidate |

(d)Language Medium for Interview

Test | ENGLISH

13. (a) Name of Father | MOHD GOUS

(a.1) Status | ALIVE
(b) Name of Mother | FIRDOUS JAHAN BEGUM
(b.1) Status | ALIVE
(c) Nationality of Father | INDIAN
(d) Nationality of Mother | INDIAN
(e) Father's Profession: | GOVT. SERVICE/PUBLIC SECTOR
(f) Mother's Profession: | TEACHING
(g) If Father is in service, post held by him | ASSISTANT ENGINEER -2
(g)(i) if retired indicate the post held
by him at the time of his retirement,
otherwise fill 'NOT APPLICABLE' | NOT APPLICABLE
(h) If Mother is in service, post held by her | TEACHER
(h)(i) if retired indicate the post held
by her at the time of her retirement,
otherwise fill 'NOT APPLICABLE' | NOT APPLICABLE
(i) Annual income of your Father for | Rs.540000
financial year 2023-2024
(j) Annual income of your Mother for | Rs.947264
financial year 2023-2024
(k) State to which your Father originally | KARNATAKA
belongs
(l) District to which your Father originally | BIDAR
belongs
(m) State to which your Mother originally | KARNATAKA
belongs
(n) District to which your Mother originally| BIDAR
belongs
(o) Father's present postal Address | 2-4-511 MOHALLA BAWARCHI GALLI BIDAR
(If deceased give last address) |
Post Office: | BIDAR
City: | BIDAR
District: | BIDAR
State : | KARNATAKA
Pin Code : | 585401
(p) Mother's present postal Address | 2-4-511 MOHALLA BAWARCHI GALLI BIDAR
(If deceased give last address) |
Post Office: | BIDAR
City: | BIDAR
District: | BIDAR
State : | KARNATAKA

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Pin Code : | 585401

14.1(a) Do you possess the prescribed Educational

Qualification (Vide rule-6 of the rules of the Examination)?
Please upload a scanned copy of the Certificate
if the answer is "YES" | YES
(b) Certificate No./Enrolment No./Roll No. | 1BI13CV067
(c) Date of issue | 2018-01-09
(d) Designation of issuing authority | VICE CHANCELLOR
(e) Full address of issuing authority | VISVESVARAYA TECHNOLOGICAL UNIVERSITY
BELAGAVI

(f)(i) Do you have any basic Educational

Qualification or higher qualification
obtained from a foreign institution? | NO

14.2 Educational Qualifications : Commencing with Matriculation or equivalent examination till Graduation:-
(Please upload scanned copy of all Certificates/Degree)
Examination Class/ Percentage CGPA Year of Subject(s) Name of Name of
Passed Division of Score Out of School/College Board/University
/Grade Marks(%) Passing /Institution
10th or Equivalent FIRST 7.6 10 2011 ENGLISH GURU NANAK CENTRAL BOARD
KANNADA PUBLIC SCHOOL OF SECONDARY
MATHEMATICS BIDAR EDUCATION
SCIENCE SOCIAL
SCIENCE
12th or Equivalent FIRST 76 2013 ENGLISH HINDI SHAHEEN IND PU DEPARTMENT OF
PHYSICS COLLEGE AHMED PRE UNIVERSITY
CHEMISTRY BAGH GOLE EDUCATION
MATHEMATICS KHANA BIDAR KARNATAKA
BIOLOGY
Stream at Graduation Level :-- ENGINEERING
B.E. FIRST 60.5 2017 CIVIL BANGALORE VISVESWARAIAH
ENGINEERING INSTITUTE OF TECHNOLOGICA
TECHNOLOGY L UNIVERSITY,
BANGALORE BELGAUM,
KARNATAKA.

14.3 Higher Educational Qualifications : Commencing with Post Graduation or equivalent examination :-
Examination Class/ Year of Date of Likely date CGPA Percentag Subject(s) College/Institution Board/
Passed/ Division Passing Joining of Score Out of e University
Appeared/ /Grade Completion of
Appearing Marks(%)

15.(i) Have you ever been employed? : | NO

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15.(ii) Have you been self-employed?: | NO

16. Have you ever been debarred by

the UPSC from any of its
Examinations/Selections? | NO

17. Whether you have ever applied for

U.P.S.C. Examination /Recruitment
(Excluding Current Examination): - | YES
Details of other application for Examination/Recruitment held/to be held by UPSC :-
Name of Examination/Post Month and Roll. No. Whether Qualified Whether Whether Whether Whether
year of appeared at for Mains appeared at you were re you havejoi continuing
Examination the Examin the commended ned/appoint till date or re
/Advt. ation Interview for appoint ed signed(with
No./Item No. ment date)
for
Recruitment
Civil Services (Preliminary) 2025-02 0000000 NO
Examination

18(a). How many times have you appeared

at the Civil Services(Pre) Examination | 4

18(b). Details of Examination in which you have appeared including CS(P) Exam
Year 2018 2019 2022 2024
Roll No. 1046949 0000000 1010179 1011693

Note: The candidates who are not in possession of their Roll Nos. for previous year
examination are advised to fill 0000000 in place of their Roll Nos.
19. Have you ever accepted allocation
to a Service/Post on the basis
of Civil Services Examination
held in earlier years? | NO
(a). Year of the Civil Services
Examination on the basis of which
you had been last allocated to
service/post |
(b). Name of service/post to which
allocated |
(c). Your Roll No. for the examination |
(d). Whether you were appointed/joined
Service? |

(e). Whether you are continuing in that

Service/Post? |

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(f). If you have resigned from such post/service
Mention date of acceptance of the resignation
by the Competent authority |

20. Please give Particulars at the University/State/National Level in respect of:-

(a)Prizes, Medals, Scholarships etc. |

(b) Sports/N.C.C. etc. |
(c) Position(s) of distinction Leadership held in |
School/College
(d) Other extracurricular activities and interests (Such |
as hobbies etc.)

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21. Your order of preference against the Services/Posts given below , for which you would like to be
considered for appointment.
Note 1 : It is clarified that the below order of services does not reflect their relative importance in the eyes of the
Government and the candidates are advised to use their own discretion while indicating preference for various
services.
Note 2: A candidate shall be required to mandatorily indicate order of preferences only for those services
participating in the Civil Services Examination for the year, for which he is interested to be allocated to. No
change in preferences for Services once submitted by a candidate would be permitted . In case preference for
none of the Services is indicated, the candidate will not be considered for Service Allocation [as per Rules
of CSE, 2025].
Note 3: The services which are not required to be opted have been shown as 'NOT OPTED.'
Note 4: A candidate who is appointed to the Indian Police Service on the basis of the results of an earlier
examination and continues to be a member of that service shall not be eligible to opt for the Indian Police
Service in Civil Services Examination, 2025.

S.N. Name of Services/Post Order of Preference

1. Indian Administrative Service 1
2. Indian Foreign Service 2
3. Indian Police Service 3
4. Indian Audit and Accounts Service, Group "A" 6
5. Indian Civil Accounts Service ,Group "A" 8
6. Indian Corporate Law Service ,Group "A" 12
7. Indian Defence Accounts Service ,Group "A" 9
8. Indian Defence Estates Service, Group "A" 10
9. Indian Information Service, Group "A" 11
10. Indian Postal Service,Group "A" 13
11. Indian Post & Telecommunication Accounts and Finance Service, Group "A" 14
12. Indian Railway Management Service (Traffic), Group "A" 15
13. Indian Railway Management Service (Personnel), Group "A" 16
14. Indian Railway Management Service (Accounts), Group "A" 7
15. Indian Railway Protection Force Service, Group "A" 17
16. Indian Revenue Service (Customs & Indirect Taxes) Group "A" 4
17. Indian Revenue Service, (Income Tax) Group "A" 5
18. Indian Trade Service, Group "A" (Gr. III) 18
19. Armed Forces Headquarters Civil Service , Group 'B'(Section Officer's Grade) 19
20. Delhi , Andaman and Nicobar Islands, Lakshadweep, Daman & Diu and Dadra & 20
Nagar Haveli Civil Service (DANICS), Group "B"
21. Delhi , Andaman and Nicobar Islands, Lakshadweep, Daman & Diu and Dadra & 21
Nagar Haveli Police Service (DANIPS), Group "B"
22. Pondicherry Civil Service (PONDICS), Group "B" 22
23. Pondicherry Police Service (PONDIPS), Group "B" 23

22. Photo-ID Proof | AADHAAR CARD (XXXXXXXX8256)

23. List of Scanned documents uploaded by the candidate:-

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--> Matriculation Certification / School Leaving Certificate as proof of date of birth or any other
certificate/document as prescribed in the rules for the exam.
--> Certificate in support of claim for age relaxation
--> The selected Photo ID Proof (viz. Aadhaar Card, Voter Card, PAN Card, Passport, Driving Licence or
any other Photo ID Proof issued by the Central/State Government.)
--> Certificate of UNDERTAKING FOR OBC/EWS CANDIDATES, as applicable in a single [Link]
original physical copy of UNDERTAKING must be submitted at the time of Personality Test.
--> Certificate in support of claim to belong to SC / ST / OBC (Non Creamy Layer)/ EWS .
--> The certificate of graduation or equivalent educational qualifications (including a copy of recognition
letter / equivalence certificate from AIU/UGC, if applicable)

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OBC ANNEXURE

1. Name of the Candidate | MOHD ZEESHAN

2. Rid | 12510481134

3. (a) Name of Father | MOHD GOUS

(b) Date of birth of Father | 1964-10-10
(c) Whether your Father is having Permanent Account | YES
Number(PAN)
(d) PAN No. of Father | AYNPM2760N

4. (a) Name of Mother | FIRDOUS JAHAN BEGUM

(b) Date of birth of Mother | 1965-02-06
(c) Whether your Mother is having Permanent Account | YES
Number(PAN)
(d) PAN No. of Mother | ASYPB0858P

5.(a)(i) Profession of father | RETIRED ASST ENGINEER

(ii) Whether your Father is/was in service. | YES

(b)(i) If in service whether he is/was working under | State Government

Central Government/State
Government/Central Public Sector
Undertaking/ State Government Public Sector
Undertaking/ Autonomous Body/ Bank/
Insurance Organisation/ Universities/ Private
Organisation/Govt-Aided School/ Others

(ii) Please write full name and address of the | ZILLA PANCHAYAT TQ HUMNABAD DIST
concerned organization. In case of BIDAR
PSU/Autonomous Body/Bank/Universities/
Insurance organizations and please provide
name and address of the Controlling
Department / Ministry/Government also.

(iii) Name of the post to which he was appointed | CONTRACT BASIS J.E
by direct recruitment

(iv) Group of the post (viz. group A, B, C or D) to | GROUP C

which he was appointed by direct recruitment
and the year of recruitment

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(v) If post of the organization is not classified as | NO ()
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 Government as per DOPT's
OM No. 36012/22/93-Estt.(SCT), dated
8.9.1993. If yes, to which it is comparable and
please upload the relevant Government
order/notification establishing such
equivalence / comparability of post if available

(vi) Complete employment details of all the posts

held by Father (From first employment till
present employment) :-

Name of the post and group of the post & Pay Scale of the post Date of Appoint Age at the Method of Recruitment
equivalence of post ment/promotion time of appoin /appointment[whether
to the post tment/promoti by Direct Recruitment/
on Promotion/Contract/oth
ers]
NA NA NA NA NA

(vii) If the father has retired/resigned or terminated | RETIRED

from service, the details of present status from
the time of retirement/resignation/termination.
If reemployed, mode of re-employment.

(viii) Whether the father has/had been in | NO ()

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

(ix) If father is dead, date of his demise |

(x) If father suffers from permanent incapacitation | NO

while in service.

(xi) If father suffers from permanent incapacitation |

while in service, date from which he so suffers

6. (a) Whether father of the candidate holds or has ever held | NO

a Constitutional post
(b) If yes, name of the post (s) and duration of holding |
such post(s)

7. (a) If father is/was in the rank of Colonel and above | NO

in the army and to the equivalent posts in the
Navy and the Air Force and the Para Military
Forces.
If yes, upload the relevant appointment order.

8.(a)(i) Profession of mother | GOVT SERVANT

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(ii) Whether your Mother is/was in service. | YES

(b)(i) If in service whether she is/was working under | State Government

Central Government/State
Government/Central Public Sector
Undertaking/ State Government Public Sector
Undertaking/ Autonomous
Body/Bank/Insurance
Organisation/Universities/ Private
Organisation/Govt-Aided School/Others

(ii) Please write full name and address of the | GOVT URDU HR PRIMARY SCHOOL C.R.S.
concerned organization. In case of PANSAL TALEEM, BIDAR
PSU/Autonomous Body/Bank/Universities/
Insurance organizations and please provide
name and address of the Controlling
Department / Ministry/Government also.

(iii) Name of the post to which she was appointed | PRIMARY TEACHER
by direct recruitment

(iv) Group of the post (viz. group A, B, C or D) to | GROUP C

which she was appointed by direct recruitment
and the year of recruitment

(v) If post of the organization is not classified as | NO ()

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 Government as per
DOPT's OM No. 36012/22/93-Estt.(SCT),
dated 8.9.1993. If yes, to which it is
comparable and please upload the relevant
Government order/notification establishing
such equivalence/comparability of post if
available

(vi) Complete employment details of all the posts

held by Mother (From first employment till
present employment) :-

Name of the post and group of the post & Pay Scale of the post Date of Appoint Age at the Method of Recruitment
equivalence of post ment/promotion time of appoin /appointment[whether
to the post tment/promoti by Direct Recruitment/
on Promotion/Contract/oth
ers]
NA NA NA NA NA

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(vii) If the Mother has retired/resigned or | NO
terminated from service, the details of present
status from the time of
retirement/resignation/termination. If
reemployed, mode of reemployment.

(viii) Whether the mother has/had been in | NO ()

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

(ix) If mother is dead, date of her demise |

(x) If Mother suffers from permanent | NO

incapacitation while in service.

(xi) If mother suffers from permanent |

incapacitation while in service, date from
which she so suffers

9. (a) Whether mother of the candidate holds or has ever | NO

held a Constitutional post
(b) If yes, name of the post (s) and duration of holding |
such post(s)

10.(a) If Mother is/was in the rank of Colonel and above | NO()

in the army and to the equivalent posts in the
Navy and the Air Force and the Para Military
Forces.
If yes, upload the relevant appointment order.

11. (A) Whether the parents of the candidate own | NO

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 irrigated land holding at |

the place where land owned is located

(d) Statutory ceiling limit of unirrigated land holding |

at the place where land owned is located

(e) 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 details

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12. Annual income(in Rs.) of father for last three consecutive financial years (year-wise) :-

Financial Year Financial Year Financial Year

2023-2024 2022-2023 2021-2022
[Assessment Year [Assessment Year [Assessment Year
2024-2025] 2023-2024] 2022-2023]
(a) Income from salary 772800 772800 772800
(b) Income from agriculture 0 0 0
(c) Income from other sources 0 0 0
(d) Whether your father has filed the ITR? YES YES YES
(d)(i) Whether the ITRs for the last 3 years in NO NO NO
respect of your father are available with you for
uploading?
(e) Undertaking ,I will submit the complete ITRs YES YES YES
to the Commission before/at the date of
interview

13. Annual income(in Rs.) of mother for last three consecutive financial years (year-wise) :-

Financial Year Financial Year Financial Year

2023-2024 2022-2023 2021-2022
[Assessment Year [Assessment Year [Assessment Year
2024-2025] 2023-2024] 2022-2023]
(a) Income from salary 947264 947264 800000
(b) Income from agriculture 0 0 0
(c) Income from other sources 0 0 0
(d) Whether your mother has filed the ITR? YES YES YES
(d)(i) Whether the ITRs for the last 3 years in NO NO NO
respect of your mother are available with you for
uploading?
(e) Undertaking ,I will submit the complete ITRs YES YES YES
to the Commission before/at the date of
interview

14. (a) Details of wealth held by parents |

(b) Whether the wealth held is above the exemption limit | NO
as prescribed in Wealth Tax Act ?

15. Whether you have any documentary proof in support | NO

of service/status/land holding/income from different
sources/property held by parents have been attached?
If yes, upload documentary proof.

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UNDERTAKING ANNEXURE-VI

I MOHD ZEESHAN son/daughter of Shri MOHD GOUS Resident of village/town/city BIDAR district
BIDAR state KARNATAKA hereby declare that I belong to the MUSLIM community which is
recognized as a backward class by the Government of India for the purpose of reservation in services as per
orders contained in Department of Personnel and Training Office Memorandum No.
36012/22/93-Estt.(SCT), dated 8.9.1993. It is also declared that I have read and understood the instructions
mentioned in the said DOPT's Office Memorandum dated 08.09.1993, and OM
No.36033/1/2013-Estt.(Res.) dated 13.09.2017 and I have reasons to declare that I do not fall under
OBC(Creamy Layer) category on the basis of the income for the Financial Years(FYs)
2023-2024,2022-2023 and 2021-2022.

DECLARATION OF OBC ANNEXURE

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 Civil Services Examination, 2025 and also be
liable for any other civil or criminal proceedings.

Place: (Signature of the Candidate)

Date: Name of Candiate: MOHD ZEESHAN

Rid : 12510481134
 Page No. 17/17
DECLARATION BY THE CANDIDATE

I, hereby declare that all statements and entries made in all the columns of this application are true,
complete and correct to the best of my knowledge and belief.

2. That I have read Rules of the Civil Services Examination, 2025 published in Part I –
Section 1 of the Gazette of India Extraordinary dated 22nd January, 2025 and understand that in the
event of any information being found false or incorrect or ineligibility being detected before or
after the examination, or flouting of any instructions given by the Commission along with e-Admit
card/ Question – cum – Answer Booklets/ e-Summon letter [Link] can be taken against me by
the Commission.

3. That I further declare that I fulfil all the eligibility conditions regarding age limits, educational
qualifications etc. prescribed for admission to the Examination. I have not exhausted the number of
attempts admissible to me under the Rules of the Examination, 2025.

4. That I have not withheld any information required as per this Detailed Application Form.

5. I have thoroughly scrutinised the list of scanned documents as enumerated and uploaded scanned
copies of all the documents relevant for me.

6. That I have read the Rules of Examination and the instructions carefully and I hereby undertake to abide
by them.

7. That I have informed my Head of the Office/Department in writing that I have applied for this
examination.

Signature of the Candidate

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