APPLICATION FOR ALLOTMENT OF COMPUTER NUMBER FOR DGCA INDIA

APPEARING IN AME LICENCE EXAMINATION CA Form 19-07

Government of India
Director General of Civil Aviation, Central Examination Organisation
FOR OFFICE USE ONLY SIGNATURE OF OFFICER

E-

Registration Temp Id: E-T2017/0341

1. PERSONAL DETAILS

Name Mr KARNATI RAJEEV REDDY

Gender Male
Paste Recent
Date of Birth 16-07-1993 coloured
Passport
Father's Name KARNATI MAHESWARA REDDY size Photograph and
Mother's Name KARNATI RAMALAKASHAMMA Signature below with
black ink
Email Address rajeevreddy1993@gmail.com
Category GENERAL
Nationality INDIA
UIDAI Number 650385991284
(Adhar No.)

Passport Security
Country Date of Issue Date of Expiry Place of Issue AIU
Number Clearance

INDIA

Correspondence Address Permanent Address

House no:5-6 BC Colony House no:5-6 BC Colony

main road gulladorthi koilkultla mandal main road gulladorthi koilkultla mandal
Kurnool Kurnool
Andhra Pradesh 518134 Andhra Pradesh 518134

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Registration Temp Id: E-T2017/0341
2. QUALIFICATION DETAILS
Level Degree / Diploma Board/ University Duration Year of Passing Percentage

10 + 2 Senior Secondary Board of Intermediate Education Andhra 2.0 2010 75.60

10+2 MARKS DETAILS

Subject Marks Obtained Maximum Marks Board/University
Physics 108.0 150.0 Board of Intermediate Education Andhra Pradesh
Chemistry 104.0 150.0 Board of Intermediate Education Andhra Pradesh
Maths 233.0 300.0 Board of Intermediate Education Andhra Pradesh
English 144.0 200.0 Board of Intermediate Education Andhra Pradesh
Other sanskrit 167.0 200.0 Board of Intermediate Education Andhra Pradesh

3. APPLICANT TYPE : GENERAL

Name of Organization / Approved institutes Stream Category
Rajiv Gandhi Academy Mechanical A1,A2,A3,A4,B1.1,B1.2,B1.3,B1.4

4. AIRCRAFT MAINTENANCE EXPERIENCE

Total Experience: 2 Years and 0 Months
DETAILS OF AIRCRAFT MAINTAINENCE EXPERIENCE
Type of Aircraft/ engines/system Organisation/Approved AME Area of Work Major/Line/ From To Period
Institute Shop/AME Institute (in months)
Cessna 152/O-235 N2C L2C/Engine Rajiv Gandhi Aviation Academy, Line maintenance 09-07-2014 02-08-2016 25

5. DOCUMENTS UPLOADED AND TO BE ENCLOSED

Enclosure No. Document Name Tick Mark DGCA Remark
1 Applicant Photograph
2 Applicant Signature
3 Xth Certificate/Date of Birth Certificate
4 XIIth / Technical Diploma Marksheet
5 XIIth / Diploma pass Certificate
6 Board Verification Certificate for Xth qualification
7 Copy of Proof of Permanent Address
8 Experience Certificate from 09-07-2014 to 02-08-2016

6. 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/entries 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(s)
It is an offence to make, with intent to deceive, any false representation for the purpose of procurring the grant, issue,renewal or variation of any certificate,
licence, 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 , it renders the person permanently ineligible to have an Aircraft Maintainance Engineer's
Licence.
I declare that I have read and understood the INSTRUCTIONS.

PLACE SIGNATURE

DATE NAME

CERTIFICATE
This is to certify that the particulars furnished by Mr/Ms . KARNATI RAJEEV REDDY given above have been verified by me and found correct.

Date: Seal of Signature:

Organisation
Place: Name
and Designation:
This certificate to be attested by QM/Chief Instructor of approved AME Training Institute/Chief Engineering Officer in case of serving Defence personnel
and Gazetted officer / Self Attested in case of PRIVATE/ Unemployed candidate.

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