APPLICATION FOR GRANT OF PERMANENT COMMISSION

Affix self
IN EDUCATION BRANCH OF THE INDIAN NAVY (MALE CANDIDATES ONLY)
attested
passport size
Regd No ………………………………… (For Official use only) recent colour
photograph
(Do not staple)
1. Applying for Course _________________________
2. Name in BLOCK Capitals as in Matriculation Certificate:-

3. Expanded Name if Abbreviated in Sl 2 above (only abbreviated part):.-

4. Father’s Full Name:-

5. Father’s Occupation/Designation........................................................................................
6. Permanent Address:-

District
Tele
State Pin

7. Correspondence Address:-

District
State Pin Mobile
Email

8. Nationality: 9. Domicile:
10. Date of Birth (DD/MM/YYYY)
11. Marital Status: MarriedUnmarried
12. Details of Marks Secured in Graduation / Post Graduation:-

Exam Marks Secured

Passed
Year / Marks Maximum % Marks Year / Marks Maximum % Marks
Semester Obtained Marks Semester Obtained Marks
Graduation . .
……………. . .
………… . .

Post 1st Year .

Graduation nd
2 Year
13. If BE/BTech, Specify Stream eg. Mechanical / IT / Electronics, etc. …………………………………………………
14. Name of College Where Studied and Address …………………………………………………………………………
15. Name of University to Which College Affiliated and Address ………………………………………………………
16. Have you attended any SSB interview earlier: (If yes, give details for all earlier attempts)

Service Type of Entry Name of SSB Month & Year of SSB Batch no Rec/ Not Rec

17. Details of service under central/ state Govt, if any ……………………………………………….

(Candidates already in service should apply through proper channel and obtain NOC from the present employer)

DECLARATION

1.I, hereby, declare that I am unmarried male, governed by nationality condition as laid down by the Government of India
and have never been debarred from appearing in any examination ,I have never been arrested/ prosecuted and convicted by a
criminal court or involved in any other case registered by the Police.
2.I, hereby, solemnly declare that all the statements made in the above application are true and correct to the best of my
knowledge and belief.
3.I fully understand that in the event of any information being found false or incorrect, action can be taken against me.

Place: …………......…….. Signature...........................................................

Date: ............................... Name of the Applicant...........................................