Marital Status and Marks Secured
APPLICATION FOR GRANT OF SHORT SERVICE COMMISSION AS PILOT IN EXECUTIVE BRANCH OF THE INDIAN NAVY (FOR MALE CANDIDATES ONLY) Regd No ………………………………… (For Official use only)
1. Applying for Course _________________________ 2. Name in BLOCK Capitals as in Matriculation Certificate:3. Expanded Name if Abbreviated in Sl 2 Above (abbreviated part):4. Father’s Name:5. Father’s Occupation/Designation........................................................................................ 6. Permanent Address:District Tele
Paste self attested recent passport size colour photograph (Do not staple)
State 7. Correspondence Address:-
Pin
State Email 8. Nationality: 10. Date of Birth
Pin 9.
District Mobile Domicile:
(DD/MM/YYYY)
11. Marital Status: Married Unmarried 12. Details of Marks Secured in Graduation and Above: Exam Passed Semester/Year Wise Marks Secured Semester / Year I II III IV Marks Obtained Maximum Marks % Marks . . . . Semester / Year V VI VII VIII Marks Obtained Maximum Marks % Marks . . . . .
TOTAL MARKS AND OVERALL PERCENTAGE
13. In case of BE/BTech, Specify Stream, eg., Mechanical/Electrical/Electronics, etc. ……………………………….. 14. Name of College Where Studied and Address ………………………………………………………………………… 15. Name of University to Which College Affiliated and Address ……………………………………………………… 16. Details of Marks Secured in 10+2 Level (mks obtained/max mks): Maths ….…./.…….. Physics .……/…… 17. Have you attended any SSB interview earlier: (If yes, give details for all earlier attempts) Service Type of Entry Name of SSB Month & Year of SSB Batch no Rec/ Not Rec
18. Are you willing to volunteer for Executive (General Service), if not qualified PABT/Aviation medicals: Yes No 19. Details of service under central/ state Govt, if any ………………………………………………. (Candidates already in service should apply through proper channel and obtain NOC from the present employer) DECLARATION
1. I, hereby, declare that I am unmarried male, governed by nationality
1. Applying for Course _________________________ 2. Name in BLOCK Capitals as in Matriculation Certificate:3. Expanded Name if Abbreviated in Sl 2 Above (abbreviated part):4. Father’s Name:5. Father’s Occupation/Designation........................................................................................ 6. Permanent Address:District Tele
Paste self attested recent passport size colour photograph (Do not staple)
State 7. Correspondence Address:-
Pin
State Email 8. Nationality: 10. Date of Birth
Pin 9.
District Mobile Domicile:
(DD/MM/YYYY)
11. Marital Status: Married Unmarried 12. Details of Marks Secured in Graduation and Above: Exam Passed Semester/Year Wise Marks Secured Semester / Year I II III IV Marks Obtained Maximum Marks % Marks . . . . Semester / Year V VI VII VIII Marks Obtained Maximum Marks % Marks . . . . .
TOTAL MARKS AND OVERALL PERCENTAGE
13. In case of BE/BTech, Specify Stream, eg., Mechanical/Electrical/Electronics, etc. ……………………………….. 14. Name of College Where Studied and Address ………………………………………………………………………… 15. Name of University to Which College Affiliated and Address ……………………………………………………… 16. Details of Marks Secured in 10+2 Level (mks obtained/max mks): Maths ….…./.…….. Physics .……/…… 17. Have you attended any SSB interview earlier: (If yes, give details for all earlier attempts) Service Type of Entry Name of SSB Month & Year of SSB Batch no Rec/ Not Rec
18. Are you willing to volunteer for Executive (General Service), if not qualified PABT/Aviation medicals: Yes No 19. Details of service under central/ state Govt, if any ………………………………………………. (Candidates already in service should apply through proper channel and obtain NOC from the present employer) DECLARATION
1. I, hereby, declare that I am unmarried male, governed by nationality