AME APPLICATION FOR APPEARING IN WRITTEN PAPER(S) DGCA INDIA

CAR 66 BASIC KNOWLEDGE EXAMINATION CA FORM 19-08A

Session: July 2017

Exam Temp ID : E-T072017/0633

1. PERSONAL DETAILS

Computer Number E-09057696

Candidate's Name Mr . Murugesan Mathi Paste here Recent
Passport
Date of Birth 28-03-1991 size Photograph and
Signature below
Father's Name Mr. Murugesan
Applicant Type General
Organisation Name null

MODULES APPLIED
Module QPREF Applied Category Exam Type Centre
Module 4 - ELECTRONIC FUNDAMENTALS 0400 B1.1 Online New Delhi

Candidates who had passed their Paper 1 before 1992 should submit their duly attested result of paper 1(Combined paper 1&2) /BAMEL/AMElicence
copy along with the application while applying for PAPER 3.

DETAILS OF LAST TWO EXAMS ATTEMPTED BY THE CANDIDATES

DETAILS OF AIRCRAFT MAINTENANCE EXPERIENCE

Type of Aircraft/ Organisation/Approved Area of Work Major/Line DURATION DURATION DURATION PERIOD
engines/systems AME Institute /Shop/AME Institute FROM TO
A320 Series/IAE Air Works India Ltd Line Maintenance 10-12-2014 08-02-2017 26
Cessna 421B GE / Air Hind Aviation Major OJT 15-01-2011 15-07-2011 6
Ab-Initio Training// Park School of AME Institute 07-07-2008 31-12-2010 30
DOCUMENTS UPLOADED AND TO BE ENCLOSED

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Exam Temp ID : E-T072017/0633

5. 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 AND DESIGNATION

CERTIFICATE
This is to certify that the particulars furnished by Mr . Murugesan Mathi given above have been verified by me and found correct.

Date and Place: Seal of Signature:

Organisation
Seal: 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 in case of unemployed persons.

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