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13 views

Application Form

Uploaded by

abhimanyushewale02
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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B.P.

MARINE ACADEMY
(APPROVED BY D.G. SHIPPING, GOVT. OF INDIA)
Sai Pooja Chambers, Sector – 11, CBD Belapur, Navi Mumbai : 400 614.
Tel.No: (91) 22-27574082 / 27565179 / 27562179 Fax No.: (91) 22-27579103
Email: [email protected]/[email protected] Website: www.bpmarineacademy.in
DECK & ENGINE (G.P) RATING Affix your recent Passport
Size Attested Coloured
CERTIFICATE COURSE IN MARITIME CATERING (Saloon Rating) Photograph
(40 mm x 30 mm)
DIPLOMA IN NAUTICAL SCIENCE (IGNOU-DGS)

B.Sc. NAUTICAL SCIENCE (MUMBAI UNIVERSITY)

HND IN NAUTICAL SCIENCE / MARINE ENGINEERING STC (MCA–UK)

HND IN NAUTICAL SCIENCE / MARINE ENGINEERING GCNS (MCA–UK)

ELECTRO TECHINICAL OFFICER COURSE (COMPANY REQUIRMENT)

HND IN BUSINESS ( STC – UK )

HND IN COMPUTING ( STC – UK)

APPLICATION FORM
No :
Name in Full
1 (In Block Letters as per 10th Std. Cert.) :
2 Date of Birth : Age : Years : Months :

3 Place of Birth :

Local Guardian’s Name


:
Address And Relationship
4
Relationship :
:
Tel. No. : STD Code :
Communication :
Address with Tel. No.
5
(Mention STD Code)
Tel. No. : STD Code :
and PIN Code :

6 Permanent Address :

Tel. No. : STD Code :

7 Nationality :

8 Passport No. (If Any) : Place of Issue :

9 Father’s Name : Occupation :

10 Academic Qualification : Year Passed Overall % English % P.C.M % Board/University

Class X / Equivalent :

Class XII / Equivalent :

BSc. / B.E. / B.Tech :

And Others ( ) :
11 Swimming : (Yes / No) Hobbies :

12 Physical Fitness : Height Cms. --- Weight Kgs.

13 Eyesight : Normal (Yes / No) Colour Blindness (Yes / No)

14 Chest : Unexpanded Cms. --- Expanded Cms

15 Identification Marks :
16 Extra Curricular Activities :

Are you a ward of a CDC No. of the


17 : (Yes / No)
Seafarer Guardian :
Are you Sponsored by any
Shipping Company Company
18 : (Yes / No)
(Attach Sponsorship Name :
Letter)

JOINT DECLARATION BY THE APPLICANT AND PARENT / GUARDIAN

We hereby declare that all the information furnished in this application is true and correct to the best of our
knowledge and belief. The original Certificates will be produced for verification at the time of admission. In the event
of any information furnished by us is found to be incorrect or false, we agree to rejection / termination of the
candidature / admission and forgo any claim whatsoever.

Date : Signature of the Applicant : .

Place : Signature of the Parent / Guardian : .

Note : Kindly submit 2 recent photographs & attested copy of all certificate
along with application.
Enclosures : (Please mention Documents you have enclosed)
1.
2.
3.
4.
FOR OFFICE USE ONLY
(THIS SHOULD NOT BE FILLED BY APPLICANT)

Registration No. and Date:_________________________________


Scrutinised By:__________________________________________
(As per STC-UK Guidelines)
Section Notice Sent On :__________________________________

Date of Reporting :_______________________________________

Medical Test Report : Fit Unfit

Selected Rejected Waitlisted

Verification of Original Documents:___________________________

Payment Details_______________________ Signature:__________________

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