1. CONFIDENTIAL
PERSONAL INFORMATION QUESTIONNAIRE
107 - A
DIPR Questionnaire No. 107- A (Revised)
O.I.R. .
Selection Board (No. & Place) Batch No. Chest No. UPSC / Other Roll No.
Name in CAPITALS (As in the matriculation certificate) __________________________________________________________________
Father’s Name __________________________________________________________________
(a)
Place of Maximum Residence (Place, District, State)
(with approximate population of the place) __________________________________________________________________
(b)
Place of Present Residence (Place, District, State)
(with approximate population of the place) __________________________________________________________________
(c)
Place of Permanent Residence (Place, District, State)
(with approximate population of the place) __________________________________________________________________
(Whether District HQ or not) __________________________________________________________________
Fill in the details below :-
(a) ? Parents Alive Yes/ No
(b)
If not alive, your age at the time of Mother’ s / Father’s death __________________________________________________________________
(c) Parents’ /Guardian’s and Siblings’ Occupatio n/income (as applicable) :-
Educational Record (commencing from Matriculatio n/Equivalent Examination) :-
State & District Married Single WidowerReligion Whether SC ST OBC Mother Tongue Date of Birth
Particulars Education Occupation Income per month
CONFIDENTIAL
Father
Mother
Guardian
Elder Brother Sister
Elder Brother Sister
Younger Brother Sister
Younger Brother Sister
Qualification
acquired
Full Name of
Institution
Board
University
Year Div.
& Marks %
Medium of
Instruction
Boarder Day
Scholar
Outstanding
achievement, if any
Matric Hr. Sec.
10+2
10+2 Equivalent
Graduation
Post-Graduation
Professional
1 AFSB DEHRADUN
RAMESH KUMAR
(Mr./Wg Cdr/Rank if any) Suresh Kumar
Delhi,North Delhi,Delhi (20 million)
Gorakhpur,Western UP,Uttar Pradesh (40 million)
Delhi,North Delhi,Delhi (20 million)
D-AFCAT(M)/109 31 IF ANY
Yes
Delhi,North Delhi Hindu NO Hindi 23/04/1991 Single
Tick accordinglyYes
-n/a-
B.A Business Rs.70,000/-
B.Com Service Rs.50,000/
-
Bsc Final Year Student -n/a-
7th Standard Student -n/a-
RP Public
School,New Delhi
CBSE 2007 FIRST,
75%
English Day
Scholar
Bronze Medal, Swimming
Nationals(2006)
Day Scholar
RP Public
School,New Delhi CBSE 2009
FIRST,
80%
English 1st Position,PERC
Debate,Kanpur
BTech,Rohilkhand University,
Gorakhpur
Rohilkhand
University
2009-
2013
79% till 7th
Semester
English Boarder
2nd Position,IEEE
Conference(2012),
Pune
HOW TO FILL A PIQ FORM??????? For more info visit www.lakshyaindia.co.nr
Start filling only when told

2. CONFIDENTIAL
/ Age ( Years & Months) / Height (in Metre) / Weight (in Kilogram)
______________________________________ _____________________________ __________________________________
Present Occupation and personal monthly income, if any ______________________________________________________________________________
(a) N.C.C. Training Yes/ No
(b) If Yes, Total Training (Give details below)
(a) Participation in games & sports :-
(b) Hobbies / Interest ______________________________________________________________________________
(c) Participation in extra-curricular, activities :-
(d)
Position of responsiblity/offices held in NCC/Scouting ______________________________________________________________________________
Sports Team/Extra-curricular group and other fields ______________________________________________________________________________
(a) Nature of Commission
(b) Choice of Service
Number of chances availed for commission in all three Services ______________________________________________________________________________
Details of all previous interviews, if any (Army Navy Air Force Selection Boards)
Total Training
Sl. No. Type of Entry
Games Sports
Name of the activity group
Wing Division Certificate Obtained
Period or duration
of Participation Represented
School / College / University / Other
Outstanding achievement, if any
Duration of Participation
Outstanding achievement, if any
CONFIDENTIAL
SSB No. & Place
Date
Chest No. Batch No.
Dont't act smart & hide your
details
SECOND2012IEEE CONFERENCE,PUNE
FIRST2008PERC DEBATE,KANPUR
CASUAL2008-2013CHESS
BRONZERP PUBLIC SCHOOL,
NEW DELHI
2006SWIMMING
READING,WRITING,PAINTING,TRAVELLING
HEAD BOY OF SCHOOL(2008-2009)
56/B-NSB(099)12/01/201333 SSB,BHOPALUES NAVY2.
12/B-ARMY(119)24/08/200918-SSB,ALLAHBADNDA1.
02
INDIAN AIR FORCE
SHORT SERVICE/PERMANENT COMMISSION
NO
Student
57kgs1.6m22 years,3 months