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CPL CPL CPL CPL CPL

Registration Temp Id: P-T2019/1654 P-T2019/1654

APPLICATION FOR ALLOTMENT OF COMPUTER NUMBER FOR APPEARING DGCA INDIA CA-9
IN FLIGHT CREW LICENCE EXAMINATION

GOVERNMENT OF INDIA
DIRECTORATE GENERAL OF CIVIL AVIATION
CENTRAL EXAMINATION ORGANISATION

FOR OFFICE USE ONLY SIGN OF OFFICER

P-

1. PERSONAL DETAILS

1.1. Name SHIVENDU KRISHNA

1.2. Gender MALE

1.3. Date of Birth 26-10-1993

1.4. Mother's Name VEENA

1.5. Fathers Name SURENDRA NATH

1.6. Email ID shivendu.krishna@gmail.com

1.7. Nationality INDIA

1.8. Mobile Number XXXXXX9583

2. Study Details

Have you studied in Foreign University, situated in India NO


or Abroad?

Do you have AIU/ equivalent education qualification NO


certificate?

3. Passport Details

Passport No. Issue Date Expiry Date Place of Issue

L7897021 13-03-2014 12-03-2024 INDIA

4. Address

Correspondence Address Permanent Address

530-R Vikas Nagar Awasiya Colony Behind Khetan 530-R Vikas Nagar Awasiya Colony Behind Khetan
Hospital Bargadwa Gorakhpur Uttar Pradesh PIN- Hospital Bargadwa Gorakhpur Uttar Pradesh PIN-
273007 India 273007 India

5. Education

Level Degree / Board / University Duration Year of Percentage


Diploma (In Year) Passing

10th - CBSE 1 2009 84

10+2 with PM - CBSE 1 2011 63

Online Submission Date & Time : 24/03/2019 & 08:58:26 Page No. 1
CPL CPL CPL CPL CPL

Registration Temp Id: P-T2019/1654 P-T2019/1654

6. 10+2 Details

Subject Marks Maximum Board/ University


Obtained Marks

Physics 60 100 CBSE

Chemistry 63 100 CBSE

Maths 33 100 CBSE

English 79 100 CBSE

Biotechnology 72 100 CBSE

Physical 71 100 CBSE


Education

7. Flight Crew Details

APPLYING FOR CPL

DEFENCE -

PILOT LICENCE TYPE -

PILOT LICENCE NO -

PILOT LICENCE ISSUE DATE -

PILOT LICENCE EXPIRY DATE -

LICENCE ISSUING AUTHORITY -

LICENCE ISSUING COUNTRY -

MULTI ENGINE ENDORSEMENT NO

COURSE COMPLETION CERTIFICATE NO -

AIRCRAFT TYPE -

AUW -

FIRST TRAINING FLIGHT -

TRAINING INSTITUTE O01

TOTAL FLYING HOURS -

TOTAL HOURS PILOT IN COMMAND -

GROUND TRAINING INSTITUTE O01

Online Submission Date & Time : 24/03/2019 & 08:58:26 Page No. 2
CPL CPL CPL CPL CPL

Registration Temp Id: P-T2019/1654 P-T2019/1654

8. Documents Uploaded and to be enclosed

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

1 - Applicant Photograph

2 - Applicant Signature

3 0052203 Date of Birth Proof

4 0052203 Xth Marksheet

5 0062998 Xth Pass Certificate

6 1127067 Board Verification Certificate for Xth


Qualification

7 616105 XIIth / Equivalent Pass Certificate

8 9179252 Board Verification Certificate for XIIth/


Equivalent Qualification

9 823063 XIIth / Equivalent Marksheet

10 2079/532 UID Aadhar Card


23/03359

11 2079/532 Copy of Proof of Permanent Address


23/03359

12 L7897021 Copy of Passport

9. Declaration

I hereby certify that the above particulars/enteries made by me are true and 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 at any time, my
candidature will stand rejected and further action can be taken against me by DGCA as per the Rules.
Further, I have read the requirement for issue/ extension of Pilot Licence/Rating, as laid down in
Aircraft Rules / CARs amended from time to time.

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



DATE SIGNATURE

PLACE NAME

10. CERTIFICATION BY COMPETENT AUTHORITY

To be attested by CFI/PII/Gazetted Officer/Notary Public. In case of serving Defence Applicant should


personnel ,this may be attested by another serving Commissioned Officer paste recent color
passport size
This is to certify that all the above particulars furnished by SHIVENDU KRISHNA have photograph.
been verified by me and found to be correct.

*Signature in full of attesting authority.......................

Date

Place

* Signature & stamp shall partly cover this page and photograph.

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