AME AME AME AME AME

Registration Temp Id: E-T2019/2906 E-T2019/2906

APPLICATION FOR ALLOTMENT OF COMPUTER NUMBER FOR APPEARING DGCA INDIA CA

IN AME LICENCE EXAMINATION Form 19-07

GOVERNMENT OF INDIA
DIRECTORATE GENERAL OF CIVIL AVIATION
CENTRAL EXAMINATION ORGANISATION

FOR OFFICE USE ONLY SIGN OF OFFICER

E-

1. PERSONAL DETAILS

1.1. Name MAFAZ KHAN

1.2. Gender MALE

1.3. Date of Birth 14-02-2000

1.4. Mother's Name FAHEEM UNNISA

1.5. Father's Name AYUB KHAN

1.6. Email ID mafazkhan0008@gmail.com

1.7. Nationality INDIA

1.8. Mobile Number XXXXXX2682

2. Study Details

Do you have AIU/ equivalent education qualification NO

certificate?

Have you studied in Foreign University, situated in India NO

or Abroad?

3. Address

Correspondence Address Permanent Address

VSM Aerospace AME Training SchoolC/o Training 35/36 3rd CROSS RBI EXTENSION TILAKNAGAR
Manager VSM Aerospace AME Training School C.A. No. JAYANAGAR 3rd BLOCK BANGALORE SOUTH
15/1 -A 13th A Cross Sector-A Yelahanka New Town Bangalore Karnataka PIN-560011 India
Bangalore Karnataka PIN-560064 India

4. Education

Level Degree / Board / University Duration Year of Percentage

Diploma (In Year) Passing

10th SSLC Karnataka Secondary Education 1 2016 80.32

Examination Board

10+2 with PCM PUC Karnataka Secondary Education 1 2018 67.8

Examination Board

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Registration Temp Id: E-T2019/2906 E-T2019/2906

5. 10+2 Details

Subject Marks Maximum Board/ University

Obtained Marks

Physics 58 100 Karnataka Secondary Education Examination Board

Chemistry 57 100 Karnataka Secondary Education Examination Board

Maths 39 100 Karnataka Secondary Education Examination Board

6. Applicant Type Details

BTO

Institute Batch No Batch Month/Year

VSM Aerospace AME Training School-B1.1 36 07/2019

7. Documents Uploaded and to be enclosed

S.No. Doc.No. Document Name Tick Mark DGCA Remark

1 - Applicant Photograph

2 - Applicant Signature

3 - Date of Birth Proof

4 - Xth Marksheet

5 - Board Verification Certificate for Xth

Qualification

6 - XIIth / Technical Diploma Marksheet

7 - Board Verification Certificate for XIIth/

Diploma/Equivalent Qualification

8 - UID Aadhar Card

9 - Copy of Proof of Permanent Address

8. Declaration

I hereby declare that the information provided in this form is correct in every respect to the best of my
❏ knowledge and belief and that nothing has been concealed or withheld by me, I understand that if any
of my particulars/enteries are found false or incorrect before or after the examination, my candidature
shall be rejected and further action can be taken against me by DGCA as deemed fit. Further, I
understand that unutilized fees paid(if any), for previous session(s), will not be adjusted, carried
forward for future examination.

It is an Offence to make, with intent to deceive, any false representation for the purpose of procurring
❏ the grant, issue, renewal or valiation of any certificate, license, approval, permission or other
document. Persons doing so render themselves liable, on summary conviction, to a fine of one lakh
rupees and / or imprisonment for a term not exceeding three months. Further, if renders the person
permanently ineligible to have an Aircraft Maintainance Engineer's License.

I declare that I have read and understood the above declaration.

❏
DATE SIGNATURE

PLACE NAME

Online Submission Date & Time : 11/09/2019 & 21:05:38 Page No. 2
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Registration Temp Id: E-T2019/2906 E-T2019/2906

9. CERTIFICATION BY COMPETENT AUTHORITY

This is to certify that all the above particulars furnished by MAFAZ KHAN have been
verified by me and found to be correct.
Paste photograph as
uploaded and get it cross
attested by competent
authority.

Date: Signature:

Place: Name:

Designation:
(STAMP OF THE AUTH. SIGNATORY)

This certificate to be attested by QM/ DyQM/ TM/ CI/ DyCI. Chief Engineering Officer in case of serving Defence personnel.

Gazetted officer / Notary Public for PRIVATE unemployed candidate.

* Signature & stamp of the competent authority should partly cover the pasted photograph.

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