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Regd. No..(For Official use only)

APPLICATION FOR GRANT OF PERMANENT COMMISSION

IN THE INDIAN NAVY FOR EDUCATION BRANCH

JUL 2010 COURSE

1. Candidates Namea) Name:

(As in Matric/Equivalent Certificate)

b) Expanded full name (if abbreviated).

2. Date of Birth:

3. Fathers Name:

4. Address:

For correspondence

Pin..Telephone/Fax No. If anyE-Mail

Permanent Address.

.

Pin..Telephone/Fax No. If any.

5. Marital Status (Married/Unmarried)

6. State to which you belong7. Nationality

8. Educational Qualification. Aggregate Percentage(In case of B.E/B.Tech specify specialization such as Mech, IT, etc)

9. Details of Marks Secured in Graduation & above

(Candidates who have not completed their graduation (i.e. appearing candidates)

need not apply; their application will not be accepted)

Examination Passedgraduation/Post

graduation or any other

Qualification

Nameof the

college

Name ofUniversity

Subjects(Main

Subjects

includingElectives)

Semester /Year wise Marks secured

Semester/year Max.

Marks

Marks

obtained

% of

Mark

12

3

4

5

6

7

8

Total

Last date for the receipt of application 18 Jan 2010

D D M M Y Y Y Y

Affix

self-attested

passport

size colorphoto

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10. Appeared/ Did not appeared in earlier for Navy/ Army/ Air Force: Yes/ No(If yes- Give details)

11. List of documents attached:a)b)c).

DECLARATION

12. I, hereby, declare that I am unmarried male, governed by nationality conditions as laid

down by the Govt of India and have been debarred from appearing at any examinationnor have I, ever been arrested/ prosecuted and convicted by a criminal court or involved

in any other case registered by the police

13. I, herby, solemnly declare that all the statements made in the above application are true

and correct to the best of my knowledge and belief.14. I fully understand that in the event of any information being found false or incorrect,

appropriate action can be taken against me.

Place:.

Date:.. Signature of the Applicant:

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