Naval Ship Repair Yard Kochi

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APPLICATION FORMAT

Regn No
(for Office use only)

ENROLMENT OF DESIGNATED TRADE APPRENTICES UNDER APPRENTICESHIP


ACT (1961)
APPRENTICE TRAINING SCHOOL, NAVAL SHIP REAPAIR YARD, KOCHI – 682004

Affix Photo
Here
(Attested by
Gazetted
Officer or ITI
Principal)
(a) Trade Applied for -
_____________________

(b) Name of Applicant (As per SSC/Matric Certificate) : ____________________

(c) Sex Male Female

(d) Fathers Name (As per SSC/Matric Certificate) - ____________________

(e) Date of Birth (As per SSC/Matric Certificate) - ____________________

(f) Educational/Professional Qualifications

Marks
Year of Max % of
Examination Passed obtaine
Passing Marks marks
d
SSC/Matriculation
ITI (theory)
ITI (Practical)
(g) Name of the ITI with Address _________________________________________

_________________________________________

(h) Category of Community: SC ST OBC GEN

(j) Whether Physically Challenged Yes No

(k) Whether son/daughter of Armed Forces


Personnel/Ex-serviceman Yes No

(l) Whether son/daughter of Defence


Civilian/Naval Dockyard Employees Yes No
(m) Address for Correspondence: _______________________________________
______________________________________________________________________
______________________________________________________________________
PIN

(n) Mobile/Landline Nos with code: _______________________________________

(p) Nearest Railway Station: ____________________________________________

(q) Active e-mail ID of candidates (compulsory): _____________________________

I hereby solemnly and sincerely affirm that the particulars furnished above are
true and correct.

Date: Signature of the Applicant

Check List of Enclosure: -


1. Passport Size Photograph (06 Nos) (Compulsory)
2. SSC/Matric Marks List & Proof of Date of Birth
3. ITI Marks List
4. Community Certificate (SC/ST/OBC Candidates Only)
5. Certificate of Physically Challenged (if applicable)
6. Character Certificate from Gazetted Officer or
Head of the Institution (Compulsory) Attested Photocopy of
7. NCC & Sports participation Certificate Original Certificates
8. Certificate, if son / daughter of Defence Civilian/ only (compulsory)
Dockyard Employees (as applicable)
9. Attested copy of PAN and Aadhar Card of candidates
(Compulsory)

DAVP/10702/11/0026/1819

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