7/31/2019 Admission Form - Form 01

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Form No. CAAMN/FRM-01 (Rev. 01)

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COMMANDER ALIS GROUP OF MARITIME COLLEGESCOMMANDER ALIS ACADEMY OF MERCHANT NAVY

COMMANDER ALIS ACADEMY OF MARITIME STUDIES

APPLICATION FOR ADMISSIONPlease tick the required course

DECK CADETS PRE-SEA TRAINING (3 Months)

GP RATINGS PRE-SEA TRAINING (6 Months)

PLEASE COMPLETE THE FORM IN BLOCK LETTERS

Personal Details:

FULL NAME (in capitals):

(As given in the records of Board/University) (Underline Surname)

Fathers Name (or Mother, if no Father):

Occupation (in full detail):

Now stationed at:

Date of Birth:(Attach copy of proofof date of birth)

Place of Birth:

Nationality:

Sex: Male / Female

Passport No.: (Only ifavailable)

Place of Issue:

Date of Issue:

Date of Expiry:

Marital Status: Height: Cms Weight: Kgs

Identification Marks (Any Two):

Color of Eyes: Color of Hair:

Nearest Domestic Airport: Nearest International Airport:

Address for Correspondence:Address of next of kin or Guardian (withrelationship) to contact in case of emergency :

Pin Code:

State:

Pin Code:

State:

Tel. No. with STD code: Tel. No. with STD code:

Fax No. with STD code: Fax No. with STD code:

E-mail: E-mail:

Affix recent passportsize photograph here

(Taken within six months)

APPLICATION

NUMBER

7/31/2019 Admission Form - Form 01

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Form No. CAAMN/FRM-01 (Rev. 01)

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Qualifications:

Name of School or college where you completed 10th Std. Or 10+2 Std.:

Name of Board/University:

Month & Year of Passing 10th Std. Or 10+2 :

Please enter details of results obtained (Enclose copy of 10th Std Marks Memo)

Subject Percentage Marks Obtained Total % in 10th STD

ENGLISH (X STD)

MATHEMATICS (X STD)

SCIENCE (X STD)

Please enter details of results obtained (Enclose copy of 12th

Std, Diploma or Degree Marks Memo)

Subject Percentage Marks Obtained PCM Aggregate %

PHYSICS (XII STD)

CHEMISTRY (XII STD)

MATHEMATICS (XII STD)

ENGLISH (XII STD)

APPLICATION RECEIVED ON INTERVIEW ON

RESULT OF INTERVIEW PASSED FAILED

MEDICAL EXAMINATION PASSED FAILED

CET PASSED FAILED Proof Submitted YES NO

SELECTED TO JOIN YES NO

Signature of Director

Further Information :

Do you play any Musical Instrument: Yes / No (If Yes) Name of Instrument:

Please give any further appropriate information to support your application eg. Achievements, Extra Curricular

Activities, hobbies, special interests, etc.

I hereby declare that I have read and understood the conditions of eligibility for the course to which I seek

admission. I fulfil the minimum eligibility criteria and I have provided necessary information in this regard. In the

event of any information being found incorrect or misleading my candidature shall be liable to cancellation at any

time and I shall not be entitled to refund of any fee paid by me to the Academy. The original certificates will be

produced at the time of interview.

Registration fee of Rs.200/- by Cash / Demand Draft No._______________ dated ________________ drawn in

favour of Director, Commander Alis Academy of Merchant Navy, Payable at Hyderabad.

________________________ ________________

Applicants Signature Date

(N.B. If you need some more copies of this application, please take photocopies)

FOR ACADEMY USE