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UNMARRIEDMALECANDIDATESONLY) APPLICATIONFORMFORSPORTSQUOTARECRUITSAGPO/SSR/MR/NMR1/201BATCH(TICKTHECHOICE) 3 FORINDIANNAVYOFFICEUSEONLY ApplicationNo.

Pasteyour
CODENO. Valid VALIDITYSTATUS Invalid

recentcolour photograph (Donotstaple)

1.

NAMEINBLOCKCAPITALSASINMATRICULATIONCERTIFICATE:

2. FATHERSNAMEASINMATRICULATIONCERTIFICATE:

3. PERMANENTADDRESSWITHPINCODE,TELENO,EMAILIDIFANY: DISTRICT STATE TELE EMAIL 4. PRESENTADDRESSWITHPINCODE.TELENO,IFANY: DISTRICT STATE TELE PIN PIN

5.

HighereducationalparticularsSSR Yearof Passing Authorityconducting Exam StatefromwhichExam Passed SerialNo.ofCertificate Marksobtained/total marks / . Percentage

6.

HighereducationalparticularsMR/NMR Yearof Passing Authorityconducting Exam StatefromwhichExam Passed SerialNo.ofCertificate Marksobtained/total marks / . Percentage

Nationalit 7. y

:________________

8.

DateofBirth(DD/MM/YY) Haveyoubeendischargedfromarmedforcesbefore? Yes/

MARITALSTATUS:Married/ 9. Unmarried 11 . SportsDiscipline/Events: 13.VisibleIdentificationMarks(atleasttwo): (a) (b)

10.

No

12.Levelofparticipation:International/National/Statelevel

DECLARATION 1. Ihereby declarethatallthestatementsmadeintheapplicationaretruetothebestofmyknowledgeandbelief andtheapplicationhasbeenfilledupbyme 2. Ihaveneverbeendebarredfrom appearinginanyexaminationnor,haveIeverbeenwithdrawnfromDefenceTrainingEstablishmentsondisciplinary grounds,norhaveIeverbeen prosecute o convicted criminalcourtorinvolvedinanyothercase bythepolice.Ihavenotsubmitted arrested, d r by registered more thanoneapplicationforthisbatch. 3. Iundertakenottomakeanyclaimforcompensationif atanystageofselection,ineligibility resul thereof t . detecte formycandidature is d

andmy candidatureiscancelledasa

4. Anywillfulmisrepresentationoffactsandconcealmentofinformationwillresultinthecancellationofthecandidatureandmaydebarmepermanentlyorforaspecified periodfromapplyingforfuture examinations Place:............................... Date


:...................... ..

......

Parentsignature

Signatureof applicant

ListofDocuments:Thefollowingdocumentsaretobeattachedbypunchingandtyingfirmlywithastrongthreadtotheapplicationinthesequencebelow: mar Attestedcopyof(a)Matriculationcertificate.(forverificationofDateofBirth) (b)10+2 certificate(c)10+2 k sheet(d)Domicilecertificate(e)Sportsmerit Certificates(f)Summaryofsportsachivements. Twoselfaddressedenvelopsofsize22x10cmswithRs10/stampaffixedononeenvelope. Note:AlltheabovecertificatesaretobeattestedbyGazettedOfficer(Thenameofattestingofficershouldbelegible).

........................................................................................................................................................................................................................ IDENTIFICATION FORM DateofBirth(DD/MM/YY)

ApplicationNo. Name(inblockcapital) Fathersname

Pasteyour recent coloured photograp h(Donot staple)

VisibleIdentificationMarks(atleasttwo):

SIGNATUREOFAPPLICANT

(a) (b)