:: ONLINE APPLICATION ::

http://joincoastguard.org/Report.aspx?7dp5abCJkgOqjMP79iiB+ZL736+...

INDIAN COAST GUARD ONLINE APPLICATION FORM Application No. : 213/101813 Roll No. : EOE/M/CH/U/213/1337 Name of the post applied for : Asst. Commandant Technical (1) (Mechanical/Aeronautical) Affix recent (2) Centre at which you wish to appear for Test :- Coast Guard Dist HQs No-5 GM passport size Pettai Road, Royapuram, Chennai-600013 colour Photo Date and Time of Reporting at Centre : 29 Jun 2012 Time 09:00:00 Priority Centre Name Full Address of the Centre CHENNAI - Coast Guard Dist HQs No-5 GM Pettai Road, Royapuram, 1 CH Chennai-600013 (3) Name of the candidate (as in Matriculation) MANOJ PAUL J Gender : Male (4) Current postal address: BETHEL,KARANAKODAM,THAMMANAM P.O, CITY: COCHIN, STATE: KERALA, DISTRICT : ERNAKULAM (5) Permanent address: BETHEL,KARANAKODAM,THAMMANAM P.O, CITY: COCHIN, STATE: KERALA, DISTRICT : ERNAKULAM (6) E-mail ID manojpauljohn@gmail.com (7) Father's name : P JOHN BABU PRASAD (8) Category General (9) Date of Birth 25 Apr 1987 (10) Nationality : Indian (11) Qualification Qualification 10+2 Institute of Engineers (India) Examination Univ/Board AggrPercent Subject Mark STATE BOARD 85.67 0 OTHER 60.2 Physics 86 Maths --NA-75 0 IsAppeared/Result Pending

(12) Knowledge of Swimming : NO (13) Proficiency in sports, National Level (attach photocopies of certificate) : NO (14) NCC certificate obtained (attach photocopy of certificate, if yes) : --NA-(15) Marital Status : Unmarried (16) Details of appearance in all previous preliminary/final Selection Board of Indian Coast Guard and SSB --NA-(17) Declaration : I, hearby solemnly declare that all the statements made in the above application are true and correct to the best of my knowledge and belief. I fully understand that in the event of any information being found false or incorrect, appropriate action can be taken against me. Place : Date : COCHIN 04/06/2012 Signature : Name of the Applicant : MANOJ PAUL J

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03-Jun-12 10:17 PM

:: ONLINE APPLICATION ::

http://joincoastguard.org/Report.aspx?7dp5abCJkgOqjMP79iiB+ZL736+...

2 of 2

03-Jun-12 10:17 PM