APPLICATION FORMAT FOR GRANT OF SHORT SERVICE COMMISSION IN THE INDIAN NAVY UNDER UNIVERSITY ENTRY SCHEME JUL

L 2012 COURSE

Regd. No.____________________(For Official Use Only) 1. Applying for:_________________ ________________Branch/Cadre 2. Name in Block Capitals as in Matriculation Certificate: -

Paste your passport size self attested colour photograph (Do not staple)

3. Expend full name if abbreviated in Serial 2 above

4. Fathers Name

5. 6. 7. . 8.

Fathers Occupation/Designation_____________________________________________ Date of Birth (DD/MM/YY) Stream of BE /B.Tech .. Total Marks of BE / B Tech: (Total of 1 st to 6th/5th Semester) Maximum marks Marks obtained Aggregate % Marks

9.

Have you ever appeared/appearing backlogs:- Write Yes/No

10. Correspondence Address:

PIN Mobile 11. Permanent Address:-

Tel No. E-Mail

Pin 12 14. 16. Nationality Marital Status: Married 13. State Unmarried 15. Gender: Male Female

Details of (Educational Qualification) of BE/B.Tech: Semester/Year wise Marks secured Maximum marks Marks obtained

Name of University Semester/ Year I II III IV V VI Total marks and overall percentage

Name of College/Institution

% of Marks

17. (a) (c) 18.

If you are eligible for more than on branch/ Cadre write your choice as 1, 2 & 3 choice Engineering (GS) Branch Electrical (GS) Branch (b) (d) Naval Architecture Cadre General Service (Executive)

From which date have you been a student of final year of the Engineering College _____________

19. Are you bonded to serve the Central of State Govt after passing out of Your Engineering examination? If so give complete details Period of bond___________________________ ______________ 20. Sports, NCC, Extra Curricula r Activities_________________________ _______________________ ( Give level of participation / achievement)

21. Have you attended any other SSB interview earlier or Navy/Army/Air force?________ ___________ (If yes, ive details for all earlier attempts)___________________________ _____________ ______________ ______________________________________________________________________________________ 22. CERTIFICATE TO BE SIGNED BY THE PRINCIPAL OF ENGINEERING COLLEGE H EAD OF THE TECHNICAL INSTITUTIONS

Certified that Shri______________________________________________ is studying in this University/College Institute and that details furnished by him in Columns 1 , 12,13 and 15 of the application form have been checked with reference to relevant records and found correct. Certified that the character so far as known to me is good. He is suitable for selection as an officer of Indian Navy.

(Office Seal) Place_______________ Signature_______ _______ Date_______________ Designation________ ____

DECLARATION 23. I, hereby, declare that I am unmarried male/female, governed by nationality condition as laid down by the Government of India and have never been debarred from appearing at any examination. I have never been arrested prosecuted and convicted by a criminal or involved in any other case registered y the police. 24. 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. 25. I fully understand that in the event of any information being found else or incorrect, action can be taken against me.

Place:____________ ________

Signature_________ ______________

Date:_____________ ________

Name of the Applicant______________

Registration No..

HALL TICKET FOR UNIVERSITY ENTRY SCHEME CAMPUS SELECTION JUL 2012 COURSE

Name :..

Branch applied for:.

Paste your passport size self attested colour photograph (Do not staple )

Date of Birth:

You are hereby authorized to appear for the Campus Selectio n Test. The venue, date and time are mentioned below:

Venue : Date :..

Time: .. (See overleaf for further details)

Please carry/follow the following: (1) (2) (3) (4) (5) (6) Carry Student College Identity Card. Report half an hour before the scheduled examination time Two recent passport photos Two Photocopy of class X and XII/ PUC marks card along with the originals. Sufficient Writing material Mobiles, calculator, or any other electronic device will not be permitted.