Admission Form - Form 01
Admission Form - Form 01
Admission Form - Form 01
01)
Pin Code: State: Tel. No. with STD code: Fax No. with STD code: E-mail: Date of Birth:
(Attach copy of proof of date of birth)
Pin Code: State: Tel. No. with STD code: Fax No. with STD code: E-mail: Nationality: Sex:
(Only if available)
Place of Birth: Passport No.: Place of Issue: Marital Status: Identification Marks (Any Two):
Male / Female
Qualifications:
Name of School or college where you completed 10th Std. Or 10+2 Std.: Name of Board/University: Month & Year of Passing 10th Std. Or 10+2 :
Please enter details of results obtained (Enclose copy of 10th Std Marks Memo)
Subject
ENGLISH MATHEMATICS SCIENCE (X STD) (X STD) (X STD)
Please enter details of results obtained (Enclose copy of 12 Std, Diploma or Degree Marks Memo)
th
Subject
PHYSICS CHEMISTRY MATHEMATICS ENGLISH (XII STD) (XII STD) (XII STD) (XII STD)
PCM Aggregate %
Further Information :
Do you play any Musical Instrument: Yes / No (If Yes) Name of Instrument:
Please give any further appropriate information to support your application eg. Achievements, Extra Curricular Activities, hobbies, special interests, etc.
I hereby declare that I have read and understood the conditions of eligibility for the course to which I seek admission. I fulfil the minimum eligibility criteria and I have provided necessary information in this regard. In the event of any information being found incorrect or misleading my candidature shall be liable to cancellation at any time and I shall not be entitled to refund of any fee paid by me to the Academy. The original certificates will be produced at the time of interview. Registration fee of Rs.200/- by Cash / Demand Draft No._______________ dated ________________ drawn in favour of Director, Commander Alis Academy of Merchant Navy, Payable at Hyderabad.
________________________
________________
Applicants Signature Date (N.B. If you need some more copies of this application, please take photocopies)
FAILED
FAILED FAILED
NO
Signature of Director
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