Government of Pakistan

FEDERAL PUBLIC SERVICE COMMISSION

Website: www.fpsc.gov.pk
Aga Khan road, F-5/1, Islamabad
Email: examination@fpsc.gov.pk
Tracking ID
Fax: 051-9213386-9203410
UAN: 051-111-000-248
ONLINE APPLICATION FOR
1317413
COMPETITIVE EXAMINATION (CSS) - 2023
Date Applied
(Written Exam)
13-NOV-22

Important Note: Signed printout of this online application form along with all required documents must
be despatched so as to reach FPSC HQs Islamabad within ten (10) days of your online application
submission date. Otherwise your candidature will be rejected.

Receiving Stamp T.R. removed for Rs.

Batch
Diary No.
No.

Roll No. 15994

Name (In capital letters as per Matriculation

1) MARIAM SAMEEN
Certificate):
2) Father's Name: FAROOQ HAIDER RIAZ
Husband's Name (in case of married female
3)
candidates):
3) Date of Birth (As per Matriculation Certificate): 15-05-1992
4) CNIC Number: 34402-2550142-8
5a) Religion: MUSLIM
Whether Non Muslim desires to be examined in
5b) Islamic Studies or Comparative Study of Major
Religions:
6a) Gender: FEMALE
6b) Marital Status: DIVORCED
DR USMAN HAIDER,FLAT NO 7,SENIOR DOCTORS RESIDENCE,WAH GENERAL
7) Postal Address:
HOSPITAL,WAH CANTT
8) Permanent Address: FAROOQ HAIDER RIAZ, STREET NO 7, USMANIA MOHALLAH,KACHERI ROAD,MANDI
BAHAUDDIN
9) Particulars about Spouse/Fiancee:
a) Nationality: b) Age: 31
AK REGIMENT MANSAR
c) Education: INTERMEDIATE d) Occupation:
ATTOCK
e) Designation: STENOGRAPHER
10) Examination Centre: ISLAMABAD
11a) Domicile: PUNJAB
11b) District of Domicile: MANDI BAHAUDDIN
12a) E-mail: driftline119@gmail.com b) Ph.Office:
c) Mobile: 0334-8007701 d) Ph.Res: 03338028116
13) Age Relaxation Claimed?: GOVERNMENT EMPLOYEE (IN SERVICE)

Applicant's Signature

(Please DO NOT Fold/Tear/Write anyting on the QR Code)

Date
 -2-
14) Education Record:
Medium
S. School/ College/ Date of Result Grade/ R/
of Name of Exam Distinctio
N University & From To Announceme Div/ Board/ University Major Subjects M/
Instructi nt Passed n
o. Location CGPA F
on
2ND
POSITION
GOVERNMENT
CHEMISTRY, ENG
DEGREE 31-MAY- BACHELOR OF UNIVERSITY OF
1 ENGLISH 30-AUG-08 17-AUG-10 Second PSYCHOLOGY, SPEECH
COLLEGE,MANDI 10 SCIENCE PUNJAB
ZOOLOGY DISRICT
BAHAUDDIN
LEVEL BY
CM
GENDER AND
WOMEN STUDIES,
ENGLISH 01-AUG-11 31-DEC-13 28-FEB-14 MSC GENDER AND
SOCIOLOGICAL
2 AIOU, ISLAMABAD First AIOU, ISLAMABAD R
WOMEN STUDIES THEORY,
PSYCHOLOGY AND
LITERTURE
TEACHING OF
CHEMISTRY,
APPLE COLLEGE OF
3 EDUCATION,MANDI ENGLISH 01-APR-12 28-FEB-14 16-MAY- BACHELOR OF
UNIVERSIY OF TEACHING OF
First R
14 EDUCATION SARGOODHA BIOLOGY,
BAHAUDDIN
EDUCATIONAL LAW
RESEARCH
UNIVRSITY OF LITERATURE,
26-NOV- MA ENGLISH UNIVERSITY OF
4 PUNJAB DISTANT ENGLISH 01-AUG-13 30-JUN-15 Second PUNJAB LITERARY R
15 LITERATURE
LEARNING CRITICISM, ESSAY
PEDAGOGY,
APPLE COLLEGE OF RESEARCH
20-MAY- MASTERS OF UNIVERSITY OF
5 EDUCATION,MANDI ENGLISH 01-AUG-14 15-JAN-16 First METHODS IN R
16 EDUCATION SARGOODHA
BAHAUDDIN EDUCA, PLANNING
AND MANAGMENT

15) Extra Activities:

S.
From To Extra Curricular Activities/ Sports/ Hobbies
No.

1 30-AUG-08 31-AUG-10 ENGLISH SPEECHES AT DISTRICT AND DIVISION LEVEL

16) Disciplinary Action/ Conviction: NO

 -3-
17) Employment Record:
S. Post and Office held Name of Organization From To Date Type of Nature BS
No. Date Organization
SED, PUNJAB MINISTRY OF EDUCATION, 04-NOV- PROVINCIAL
1 EST (SCIENCE) 23-AUG-12 PERMANENT 15
PUNJAB 22 GOVT.

18) Languages (A=Excellent B=Good C=Fair):

S.
Name of Language Read Write Speak Certificate/ Diploma, if any
No.
1 ENGLISH B B B

2 PUNJABI C C C

3 URDU B B B

19) Full particulars of Near Relations:

S. Name of Relatives Relationship Post held/ Department Place of Duty
No.

1 DR.USMAN HAIDER BROTHER CONSULTANT SURGEON WAH GENERAL HOSPITAL,TAXILA

SISTER IN LAW / GOVERNMENT OF RAASUL KHAIMAH,

2 ASMA RAZZAQUE SCIENTIST LAB INCHARGE UAE

3 MEHWISH BI BI SISTER IN LAW HEALTH DEPARTMENT KUWAIT KUWAIT

Optional Subjects (600 Marks):

20) Candidates will be responsible for any error in the selection of subjects marked by them as wrong selection/combination of subjects will lead to
rejection under the Rules. Combination of optional subjects once chosen at the time of submission of online application shall not be allowed to
change subsequently. Change of optional subjects in hard copy of online form is also not allowed.

S. Subject
Subject Marks
No. Code
1 14 Political Science 200
2 23 Public Administration 100
3 26 History of Pakistan & India 100
4 31 Gender Studies 100
5 46 Psychology 100
 -4-
21a) Whether Disabled?: NO
21b) Assistance Required?: NO

22) Particulars about Parents:

S. Occupation/ Occupation/ Parent Annual Any other source of income/
No. Parent Age Qualification Designation Designation (at Alive or Income supporting income
present time of your birth) Dead
HEAVY VEHICLE
1 FATHER 67 INTERMEDIATE FREE ALIVE NONE NONE
DRIVER
HEADMISTRESS
2 MOTHER 52 MASTER FREE PRIVATE SCHOOL ALIVE NONE NONE

23) Brothers/ Sisters:

S.
B, S, SB, SS OR X Age Occupation Education
No.

1 BROTHER 38 RESEARCHER ISLAMIC RESEARCH CENTER LAHORE MPHIL

2 BROTHER 40 ENGINEER GRADUATION

3 YOUR-SELF 30 ELEMENTARY SCIENCE TEACHER MASTER

4 BROTHER 41 CONSULTANT SURGEON OTHER

5 BROTHER 34 FREE LANCER MASTER

10

24) Detail of any previous attempt for Competitive Examination (CSS):

S. Year Roll No. Examination Result Group
No.

1 2016 4867 CSS FAIL

4
 -5-
25) Occupational Groups:
Order of
Occupational Groups/ Services
Preference
1 Pakistan Administrative Service
2 Police Service of Pakistan
3 Foreign Service of Pakistan
4 Inland Revenue Service
5 Pakistan Customs Service
6 Military Lands & Cantonments Group
7 Pakistan Audit and Accounts Service
8 Office Management Group
9 Commerce and Trade Group
10 Railways (Commercial and Transportation) Group
11 Information Group
12 Postal Group

Previous experience of Psychological

26a) NO
Test:
 -6-
27) Check List: Please confirm that the following documents have been attached
with the application form: Yes / No
1. All documents attached with the form must be numbered in continuation with the page number
of the application form in following sequence:-
Original Treasury Receipt for Rs.2200 Dated: 08-NOV-22, Fee deposited in NBP Branch Name National Bank of Pakistan,
a
wah cantt Bank(Branch Code): NBP-0415 City/District: RAWALPINDI

b Recent 4 Photographs (attested on back side, mentioning name and father's name).

c Attested copy of Computerized National Identity Card.

d Attested copy of Matriculation Certificate showing date of birth. Provisional Certificate/ Result Card/ Marks Sheet is not
acceptable.

e Attested copy of Intermediate Certificate. Provisional Certificate/ Result Card/ Marks Sheet is not acceptable.

f Attested copy of Degree(s).

g Attested copy of self Domicile Certificate.

h Certificate for Buddhist and Scheduled Caste Candidates. (Annex-A)

i Certificate for Provincial/ Federal Tribal Areas candidates and those belonging to Gilgit-Baltistan. (Annex-B)

j Certificate from Kashmir Affairs Division for Azad Kashmir Nationals. (Annex-C)

k Certificate for Minorities. (Annex-D)

l Departmental Permission Certificate (Annex-E) (for Government Servants).

m In case of Ex-Employees of Armed Forces of Pakistan No Objection Certificate from relevant authority.

n In case of Disabled candidates, certificate of disability from the competent authority.

o Whether you have signed the application (first and this page)?

2. If additional documents are attached with application form, please attach a separate list:-
28) Declaration:
I certify that the statements I have made in this application are true to the best of my knowledge and belief. I understand that if any of the above
(i) statements is false in any material respect or omits any material information relevant to my previous examinations, service etc. my application is
liable to be rejected and if appointed my appointment is liable to be terminated.
(ii) I hereby declare that I am not in possession of any domicile certificate other thatn District MANDI BAHAUDDIN as claimed/submitted alongwith
the instant application form. I further declare that if I am found in possession of any domicile certificate other than the one mentioned above, my
candidature for instant examination may be cancelled/rejected and if appointed, I will be liable to dismissal from service any time with costs or
any other penalty.
(iii) I hereby further declare that:
a. I have never been involved in any criminal or civil case or prosecuted in any criminal/civil or quasi judicial proceedings involving moral
turpitude. If so, please give detailed particulars of the incident with name of police station.
b. I have not been associated with any banned militant, ethnic or terrorist organization at any time.
c. My parents, in-laws and any of my close relations have not been associated with any banned terrorist, militant organization.
d. I have read and understood "Rules for Competitive Examination", and 'Regulations for Physical Examination' before filling this application form
and agree to abide by them.

Place:__________________________________

Date:__________________________________

(Please DO NOT Fold/Tear/Write anyting on the QR

Code) Signature of Applicant
 -7-
Roll No. 15994 /2023- Roll No. 15994; /2023-
CSS CSS

Name: MARIAM SAMEEN Name: MARIAM SAMEEN

DR USMAN HAIDER,FLAT NO 7,SENIOR DR USMAN HAIDER,FLAT NO 7,SENIOR

Address: DOCTORS RESIDENCE,WAH GENERAL Address: DOCTORS RESIDENCE,WAH GENERAL
HOSPITAL,WAH CANTT HOSPITAL,WAH CANTT

District: District:

Roll No. 15994 /2023- Roll No. 15994 /2023-

CSS CSS

Name: MARIAM SAMEEN Name: MARIAM SAMEEN

DR USMAN HAIDER,FLAT NO 7,SENIOR DR USMAN HAIDER,FLAT NO 7,SENIOR

Address: DOCTORS RESIDENCE,WAH GENERAL Address: DOCTORS RESIDENCE,WAH GENERAL
HOSPITAL,WAH CANTT HOSPITAL,WAH CANTT

District: District:

Roll No. 15994 /2023- Roll No. 15994 /2023-

CSS CSS

Name: MARIAM SAMEEN Name: MARIAM SAMEEN

DR USMAN HAIDER,FLAT NO 7,SENIOR DR USMAN HAIDER,FLAT NO 7,SENIOR

Address: DOCTORS RESIDENCE,WAH GENERAL Address: DOCTORS RESIDENCE,WAH GENERAL
HOSPITAL,WAH CANTT HOSPITAL,WAH CANTT

District: District:

..............................................................................................

Acknowledgement Receipt

Received Application Form No. ________________________ of Competitive Examination, 2023

(Written Exam) of
Mr./Miss/Mrs. MARIAM SAMEEN

Signature and Official Stamp

(with date) F.P.S.C.