www.cce.upes.ac.

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ADMISSION FORM
Please tick the program you are applying for:
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Date: //

B.Sc - Maritime Studies (Lateral Entry) MBA - Port & Shipping B.Sc (Maritime Studies) + MBA (Port & Shipping)

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Affix Photograph

Personal Details

IMPORTANT GUIDELINES: All the below mentioned field are mandatory. Please mention N/A wherever not applicable

1. 2. 3.

Name (in Block Letters) Date of Birth Correspondence Address

: : : Gender M F

Pin 4. Permanent Address :

Pin 5. 6. 7. 8. Telephone (Res.) Email Nationality Occupation : : : : Mobile :

Centre for Continuing Education (CCE)

University of Petroleum & Energy Studies

) : 13. Name of the Company : : : 10. Certificate of competency details (if applicable) : 14. Designation 11. Company’s Address 12. Telephone (Off. Experience : Educational Qualifications Stream %/Grade Board/University Year of Passing From To Class X Class XII Graduation Post Graduation Any Other Work experience Name of the Organization Designation Years of Experience From To Your interest in joining UPES? Centre for Continuing Education (CCE) University of Petroleum & Energy Studies .9.

and expected behavioral norms in line with the University’s special charter for the Oil & Gas Industry.....Licenses Obtained (if any) – Technical/Non-technical Name Agency Validity Special Achievements How did you hear about us?  Website  Newspaper  Emailer Magazine  Any Other............... including dress code. Declaration I hereby state that the information given above is true to the best of my knowledge........ I shall abide by the rules and regulations of the University of Petroleum and Energy Studies... In case any information is found to be incorrect.. my candidature is liable to be cancelled by the University..... I shall ensure timely payment of all applic able dues....... Date: // Student’s Signature Centre for Continuing Education (CCE) University of Petroleum & Energy Studies .

upes. : : : 10.www. Please mention N/A wherever not applicable 1. Emergency Contact No. Permanent Address : 9. Blood Group Authorized Signatory Centre for Continuing Education (CCE) Specimen Signature of the Student University of Petroleum & Energy Studies . 11. 3. Telephone No. 4. (For Office use only) : Student’s Name (in English Capital Letters) : Father’s Name Mother’s Name Correspondence Address : : : 5.cce.Sc . B.Maritime Studies (Lateral Entry) MBA .Port & Shipping B. 7. 8. 6. Name of Program :    2.in INFORMATION FORM FOR IDENTITY CARD IMPORTANT GUIDELINES: All the below mentioned field are mandatory.ac.Sc (Maritime Studies) + MBA (Port & Shipping) Affix Photograph Duration of the Program : Enrollment No.

11. 7.Ltd.(through demand draft) in favor of “ Indico Marine Pvt.com Web: www. Certificate of competency details (if applicable) (photocopy should be self attested). You’re CV. 1. 2. Plot-37. 6. 10. Non-refundable Admission form fees of Rs. Any other degree/diploma/certificates (as mentioned in the application form). Completed ID form. Graduation certificate & mark sheets (photocopy should be self attested).Pooja (+ 91 9920073451) Mr.400 614 Tel: + 91 22 27580015 / 6 Email: indicoeducation@gmail.ac.indicoeducation. Sector-11. 5. Mayuresh COSMOS. Ltd.Anuj Nautiyal (+ 91 9820576509) INDICO Education Indico Marine Pvt. 3. 1203.INSTRUCTIONS FOR SENDING THE ADMISSION FORM Please send the filled in Admission Form along with: 1.org www. 9.cce. 4.000/. payable at Mumbai Xth & XIIth class certificate and mark sheets (photocopy should be self attested).in University of Petroleum & Energy Studies . CDC copy and relevant sea experience proof (photocopy should be self attested). CBD Belapur. 12. Work experience certificate(s). 8.org Centre for Continuing Education (CCE) www. New Mumbai . On confirmation fees to be paid to UPES in favor of “UPES FEE ACCOUNT” payable at “DEHRADUN” All these documents should reach us at the earliest at the following address: Ms. 2 passport size photographs.indicoeducation.”.upes. Post graduation certificates & mark sheets (photocopy should be self attested).