DALIAN MARITIME UNIVERSITY

&
CINEC MARITIME CAMPUS
Colombo International Nautical & Engineering College
Millennium Drive , IT Park , Malabe.Sri Lanka.
Tel: 0112413500 Fax: 0112413505 www.cinec.edu

Office Use
Ref

ENROLMENT APPLICATION FORM

NavigaCadet Training (Bsc Maritime Science - PI)

Engineering Cadet Training (Bsc Marine Eng - PI)
Foundation Course (Nav / Eng)

Batch No:

PLEASE COMPLETE ALL SECTIONS / USE BLOCK CAPITALS

1

Personal Details:

Title : Capt/Mr/Ms

Name in full (underline surname)

Date Of Birth(DD/MM/YYYY):
Sex: M/F

ID/PP/CDC:
Nationality:

Home address:

Postal code
Telephone:

Moblie:

E-mail address:
2

Next of kin:
Name:
Address:

Relationship:

Telephone:

Photo

School (s) attended

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To
To

Educational
G.C.E. (O/L):Year

G.C.E. (A/L):Year

Index No

Index No
Subject

Subject

Grade

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Grade

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4. .....................................................
5. .....................................................

10. ...............................................................
5

Extra Curricular Activities

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Statement : State briefly as to why you decided to take up a career in logistics field
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Non-related Referees
Name
Address

................................................................. Tel. No
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Name
Address

................................................................. Tel. No
........................................................................................................................

I do hereby declare that the above particulars are true and correct.
Date:

...........................................

Signature of applicant ....................................

OFFICE USE ONLY

Trainability & Suitability of the applicant: ...................................................
Course Code Batch

Date

Pre qualifications
(Cert no/Dates)

Checked by: ........................................

Date: ...................................................

Registration No: Remarks

HODs Signature: ...................................

Date: ...................................................