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Regd. No....................

(For Official use only) APPLICATION FORMAT APPLICATION FOR GRANT OF PERMANENT COMMISSION IN THE INDIAN NAVY FOR NAVAL ARMAMENT INSPECTION CADRE OF THE EXECUTIVE BRANCH - JAN 2011 COURSE
INSTRUCTIONS FOR FILLING UP THE FORM 1. 2. 3. 4. 5. 6. Application form to be filled in English only in block capitals. Strike out whatever is not applicable. Attach attested copy of class Tenth certificate for date of birth verification. Attach attested copies of all other educational certificates. Application and enclosures to be properly tagged together by thread or stapled to avoid any loss. Candidate submitting more than one application will be disqualified.

LAST DATE FOR RECEIPT OF APPLICATION 21 AUG 2010 1. 2. 3. Candidate’s Name in Block Capital as in Matriculation Certificate:Expand full name if abbreviated in Serial 1 above:Affix self Attested recent Passport size colour photograph

Date of Birth (DD/MM/YY) (As per Matric /Equivalent Certificate: Should be between 02 Jan 1986 & 01 Jul 1991. Both dates inclusive) Father’s Name:Father’s Occupation/Designation……………………………………………. Correspondence Address:-

4. 5. 6.

PIN Mob. 7. Permanent Address:-

Tel. No. E-mail

PIN 8. 9. 11. Marital Status: Nationality Married Unmarried 10. State

Educational Details:(a) Educational Qualification ……………………... Aggregate. Percentage……………… (BE/B Tech & Stream e.g. Mechanical/Electrical/Electronic etc.) (b) Name of the College along with Address from Where Studied ………..…………………………………………………………………………………………. (c) Name of University along with Address to which college /institution is affiliated ………………..………………………………………………………………………………….

... Date : ............. 13.. indicate (for all the earlier attempts):Navy Army Air Force (a) Type of Entry ________ _________ _________ (b) Name and Station of SSB ________ _________ _________ (c) Batch No. Signature...... I hereby declare that I am unmarried male/female governed by nationality conditions as laid down by the Govt.... if necessary) (Attested copies of mark sheet of each semester/year must be attached..... Name of the Applicant. if any ………………………………………..... 18. I have neither been arrested/prosecuted and convicted by a criminal court or involved in any other case registered by the Police..(Candidate who have not completed their BE/B...... 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.12........... appropriate action can be taken against me.... (b) ………………………………………. 17. (d) ……………………………………….. Details of service under Central/State Govt. In case evaluation is in grades..... DECLARATION 16..... certified equivalent marks to be indicated).. I fully understand that in the event of any information being found false or incorrect. (Candidate already in service should apply through proper channel and obtain NOC from the present employer). Details of Marks Secured in Graduation & above: .... Tech (i..... Their application will not be accepted) Subjects (Main subjects including Electives) Semester /Year wise Marks secured Semester/ Year 1 2 3 4 5 6 7 8 Total: Maximum marks Marks obtained % of Marks Examination Passed Graduation / Post Graduation or any other Qualification Graduation ……… ……… ……… Post Graduation Other Qualification (Please attach extra sheet.... 15. List of documents attached:(a) …………………………………………. of India and have never been debarred from appearing at any examination.. ________ _________ _________ (d) Month and Year of Interview ________ _________ _________ (e) Whether Recommended ________ _________ _________ 14.. candidates appearing for semester exams need not apply............. Have you attended any other SSB interview earlier? If yes...... (c) ………………………………………….e...... Place : .... .