Form No. CAAMN/FRM-01 (Rev.

01)

COMMANDER ALIS GROUP OF MARITIME COLLEGES

COMMANDER ALIS ACADEMY OF MERCHANT NAVY COMMANDER ALIS ACADEMY OF MARITIME STUDIES
APPLICATION NUMBER

APPLICATION FOR ADMISSION

Please tick the required course

Affix recent passport size photograph here

(Taken within six months)

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

Pin Code: State: Tel. No. with STD code: Fax No. with STD code: E-mail: Date of Birth:
(Attach copy of proof of date of birth)

Pin Code: State: Tel. No. with STD code: Fax No. with STD code: E-mail: Nationality: Sex:
(Only if available)

Place of Birth: Passport No.: Place of Issue: Marital Status: Identification Marks (Any Two):

Male / Female

Date of Issue: Date of Expiry: Height: Cms Weight: Kgs

Color of Eyes: Nearest Domestic Airport: 1|Page

Color of Hair: Nearest International Airport:

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

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
ENGLISH MATHEMATICS SCIENCE (X STD) (X STD) (X STD)

Percentage Marks Obtained

Total % in 10th STD

Please enter details of results obtained (Enclose copy of 12 Std, Diploma or Degree Marks Memo)

th

Subject
PHYSICS CHEMISTRY MATHEMATICS ENGLISH (XII STD) (XII STD) (XII STD) (XII STD)

Percentage Marks Obtained

PCM Aggregate %

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

APPLICATION RECEIVED ON RESULT OF INTERVIEW MEDICAL EXAMINATION CET SELECTED TO JOIN INTERVIEW ON

PASSED PASSED PASSED YES

FAILED

FAILED FAILED

Proof Submitted YES NO

NO

Signature of Director

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