ORISSA MARITIME ACADEMY

APPLICATION FORM FOR PRE SEA G. P. RATING COURSE

At/Po: Paradip Port, Orissa-754142

Index No. For Office use only.

Affix Passport size Photograph here

To be filled in Capital letters only. 1. Name of Candidate (as written in Board Certificate)

2. Name of Father or Mother or Guardian

P 3. Address:
With name of state

I

N

4.Contact Telephone No. & Mobile No 5. If ST/SC write YES D D Examination passed 10th pass +2 Level Others 8. Height in Centimeter 9. Do you have any chronic ailment 10. Occupation of Father 11. Occupation of Mother 12. Do you have any of relatives associated with shipping field? If yes specify13. Enclosed DD/bank counter foil Amt Rs.200/- as application fees No. Place: Date: Dated: Weight in Kgs. If yes, please specify. M M Y1 Y 9 % marks In English Name of Board/University

6. Date of birth 7. Percentage of marks Obtained in 10th pass (& in +2 Levels, if any).

Year of Passing

Aggregate %

Signature of Applicant

e) See our website www. c) Attach attested copies of your certificates. Note 2:d) We will not reply to ineligible candidates.Note:1. 20219850316 .com for selection list f) Our Bank: ALLAHABAD BANK. PARADIP BRANCH (ORISSA) SB A/C no.orissamaritime. Before applying make sure. a) Your age is between 17 ½ yrs & 25 Yrs and Eye sight is Normal b) You have minimum 40% aggregate in 10th standard & 40 % in English in 10th or in +2.

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