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Service Application

Thane, Maharashtra, India
January 25, 2018

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Akhaura Road, Agartala - 799001

Application Form

A. Post / Services Applied For

Full Signature of Candidate

5. Date of Birth :

Photograph of the




size recent



Not to be attested

Do not Pin Or Staple

D D MM Y Y Y Y 6. Sex : 0 Male 0 Female

11. If currently employed,

C. Advertisement No.:

( as recorded in Madhyamik or equivalent Certificate ) 12. Whether Ex-serviceman :

if yes, period of war service :

B. Preferences of Post/Service (Post Code) :

Item No.:

1st 2nd 3rd 4th 5th

(where applicable)

For Office Use Only

Receipt Regd. No. Full Signature of the Candidate

15.Tel No. With STD Code :

16. Mobile No. :

17. Choice of Center :

(where applicable)

13. Present Address :( In capital letters) 14. Permanent Address : ( In capital letters) PIN :



Allotted Roll No. 0 Yes 0 No month(s)

0 Agartala 0 Kolkata

Please mention whether in Govt. Deptt. 0 PSU/Autonomous Body b) Whether NOC enclosed 0 Yes 0 No c) Whether applied through proper channel 0 Yes 0 No INSTRUCTIONS : 1) Read all the instructions carefully before filling the form. 2) Write with Black Ball Point Pen in boxes using English Capital Letters Only. 3) Do not make any stray marks on this application form, do not stapple pin, wrinkle, scribble, tear, wet or fold this sheet as it will be scanned by computer. 4) Fill appropriate circle like this wherever necessary and not in any other form. 1. Name of the Applicant (Write within the boxes in capital letters ) : 2. Father’s Name :

3. Mother’s Name :

4. Husband’s Name ( In case of married woman ) :

(b) Whether SC/ST/OBC/Others Certificate issued by competent authority of Government of Tripura.

0 Yes 0 No

9. Physically Handicapped : 10. Whether BPL Family Card Holder : 0 Yes 0 No 0 Yes 0 No

8.(a) Category : 0General 0SC 0 ST 0 OBC

7. (a) Nationality : 0 Indian (b) State belongs to: 0 Tripura 0 Other than Tripura


a(i). a(ii). 0

2) Fill up the items which are applicable only.

18.(a) Educational Qualification (From Madhayamik onwords): Sl. No. Examination Board / University Division Percentage Of Marks 1.



Year of



NOTE : Affix the Receipt of recruitment

fee deposited to the A/C. No. 14711

of Tripura Gramin Bank, Agartala Branch

payable through any of branch of Tripura

Gramin Bank located at different places,

for the applicants within the state. In case

of applicants out side the State, the

prescribed Recuitment fee is to be paid

to the Ac/No.311******** of State Bank

India (core banking branches) in favour

of the Secretary, Tripura Public

Service Commission.


Enclose:- Self attested photocopies of the documents in respect to Sl. Nos. 5, 7(a), 8(a), 9, 10, 11, 12, 18(a) & 18(b). Dated : D D MM Y Y Y Y

I hereby declare that statements made and information furnished as above are true and correct to the best of my knowledge and belief.


Full Signature of the Applicant

22.(a) Fee paid Rs.:

( Rupees only.

(b) Challan number

Dated : D D MM Y Y Y Y

21. Have you ever been debarred / disqualified by the U.P.S.C / State P.S.Cs from appearing at its examination / selection.

0 Yes 0 No If yes, give details. 20.(a) Name of optional papers/subjects in

abbreviated form (as mentioned in

respective service rules ):

3. 4.

(b) Whether opted for :

( for TCS / TPS Grade-II and other examination)

Bengali Composition & Translation (OR) Alternative English :- 1. 2.

19. Necessary particulars to be filled in, if stipulated in the advertisement :-

(b) Any claim on relaxation in Height : 0 Yes 0 No if yes, reason :

(a) Physical measurement for the post :- Height: cm. Weight: kg. Chest normal: cm. Chest expanded: cm.

(c) Any other additional information like to mention in support of suitability for the post :-

(b) Experience :





* 1) Attach extra sheet wherever necessary.

. %

. %

. %

. %

. %



(To be filled in by the candidate)

Admit Card

Full Signature of Candidate

1. Name of the Applicant (write in capital letters) : 2. Father’s Name :

5. Present Address

3. Mother’s Name :

Photograph of the Candidate



size recent



Not to be attested

Do not Pin Or Staple

4. Husband’s Name ( In case of married woman ) :

( in capital letters ) :

Roll No Date N.B.:-

1) The candidate is to bring and use Black Ball Point Pen for furnishing answers on supplied OMR sheets Name of the Examination/Screening Test:


Name of Optional Papers offered ( when asked for ) :

(i) (ii)

(iii) (iv)

Whether Bengali Composition & Translation

(OR) Alternative English

For Office Use Only

( when asked for ) :

Name of the Centre Controller of Examinations

for preliminary exam. / screening test to be conducted under Multiple Choice Question system. 2) This Admit card is provisional and do not confer any right against rejection of his/her candidature at any subsequent stage on detection of wrong / incorrect information towards eligibility. 3) No TA/DA will be paid by the Commission for appearing at the Examination/ Screening Test. 4) Instructions to the candidates appearing for the written examination/ Screening Test- a) Do not carry Mobile phones/ electronic gadgets/ programmable calculator etc. in the examination campus. b) Do not enter in the Examination Hall after 15 minutes from commencement and no books/ papers c) Do not write anything in the Admit Card / Question paper. d) Do not to adopt any unfair means or attempt to indulge in any disorderly or improper conduct in the except Admit card will be allowed in the Examination Hall. Examination Hall.

e) Do not leave the Examination Hall for toilet before completion of 1 st

one hour and during the last 1 2

(half) an hour of the examination.

f) Do not carry Examination materials to the toilet and slip away from toilet. g) Do not leave the examination hall till the expiry of the of Examination. Before leaving, Candidates must deposit the answer scripts to the Invigilator on duty in the hall.

>>Any violation of which may lead to disciplinary action. Instructions to the candidates

1. The application should be submitted in the prescribed FORM only which is available fron the Tripura Gramin Bank Branches/Extensions counters on deposit of the prescribed fee as notified in the advertisement. Prescribed application form can be downloaded and must be printed in colour font (A4 size 90 GSM paper) from the website “” or “”. The prescribed form contains 4(four) pages in complete out of which 1st and 2nd pages are meant for the particulars of the applicant, the 3rd page is to be used as ADMIT CARD carrying important instructions to the candidates for appearing in the Examination/Screening Test. The 4th page (back page) contains the necessary instructions to the candidates.

Applicants must be in possession of the prescribed minimum qualification(s) and experience(s) for respective post(s) on the closing date for submission of application as mentioned in the advertisement. 2.(a) The application should be filled-up in complete form by own hand writing using black ball point pen only. Prescribed fee is to be deposited to the Tripura Gramin Bank, A/C No. 14711 in favour of the Secretary, Tripura Public Service Commission, Agartala through any branch /Extension counters of Tripura Gramin Bank within the State. For the candidates outside of the State, the prescribed Recruitment Fee is to be paid to the A/C No. 311******** of the State Bank of India (core banking branches) in favour of the Secretary, Tripura Public Service Commission, Agartala. The said deposit Bank Receipt is to be affixed in the specified box on the 2nd page of the Application Form.

(b) Two copies of stamp size recent photograph are to be affixed on the indicated boxes one in the 1st page & the other in the 3rd page.

(c) Date of birth should be written in Christian Era as recorded in Admit Card of Madhyamik / School Leaving Examination.

3. The followings are to be enclosed along with the filled-in Application Form if otherwise not instructed in the advertisement.

(i) Self-addressed envelope (28cm X 12cm) bearing postage worth Rs.5/- (Rupees Five) only affixed thereon for sending the Admit Card.

(ii) In case of application sent by post, another self-addressed Post-Card indicating the Advertisement No., Item No. and name of the Post applied for is to be sent along with the application form. It will be used for acknowledgement of receipt of the application.

(iii) Self-attested copies of the certificates/documents as per requirement of the Application Form.

(iv) While sending by post, the envelope cover to be superscribed as “Application for the post of

(v) If employed, must apply through proper channel or attach a “No Objection Certificate” from his/her employer. However, an advance copy along with copies of all required certificates/documents be sent to the Commission and another photocopy of the filled-in application to be sent through proper channel. If employed after submission of application, “No Objection Certificate” from the concerned employer to be produced at the time of interview.

(4) The applications may be submitted either in person or by post. Duly filled-in application must reached to the Secretary, Tripura Public Service Commission, Agartala, West Tripura on or before the last date of submission of application as indicated in the advertisement for the post(s). The Commission will in no case be responsible for non-receipt of their applications or any delay in receipt thereof on any account whatsoever. No application received after the prescribed last date will be entertained under any circumstances and all the applications received after the closing date will be summarily rejected.

(5) Any application incomplete in any form or defective or containing statements which are incorrect or false or if there is any suppression of facts, is liable to be summarily rejected. If such discrepancies detected even at the subsequent stage, it is also liable to be rejected. No correspondence or queries from applicants will be entertained.

(6) No TA/DA will be paid by the Commission for appearing at the Written Examination/Screening Test or Interview. 7.(a) The benefit of reservation of vacancy is applicable only to SC/ST candidates approved by the Govt. of Tripura as per Rule in force. SC/ST candidates of other staes may apply only for unreserved vacancy as general candidates.

(b) Upper age relaxation of 5 years is admissible for SC/ST/PH candidates and Govt. Employees. 8. The prescribed esential qualifications are minimum and mere possession of the same does not confer any right to the candidates to be called for interview except in case of scheduled examination(s). Where the number of applications received in response to the advertisement is large and it will not be convenient or possible for the Commission to interview all those candidates, the Commission may restrict the number of candidates for interview to a reasonable limit on the basis of qualifications and experience higher than the minimum prescribed in the advertisement or by holding a Screening Test. 9. Canvassing in any form at any stage will disqualify a candidate. N.B.:- For detailed instructions to the candidates relating to examination, please visit the website.


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