Regd. No…………..

(For Official use only)

APPLICATION FOR GRANT OF PERMANENT COMMISSION
IN THE INDIAN NAVY FOR EDUCATION BRANCH
JUL 2010 COURSE

Last date for the receipt of application 18 Jan 2010

1. Candidates Name Affix

a) Name:………………………………………………………………… self-
(As in Matric/Equivalent Certificate) attested
b) Expanded full name (if abbreviated)…………………………………. passport
size color
2. Date of Birth: D D M M Y Y Y Y photo

3. Father’s Name:………………………………
4. Address:
For correspondence…………………………………………………………………
……………………………………………………………………………………………
……………………………………………………Pin………………………..
Telephone/Fax No. If any………………………………E-Mail……………………
Permanent Address………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………Pin………………………..
Telephone/Fax No. If any……………………………………. ……………………
5. Marital Status (Married/Unmarried)…………………………………………………
6. State to which you belong……………………………………………………………
7. Nationality……………………………………………………………………………
8. Educational Qualification……………………. Aggregate Percentage………
(In case of B.E/B.Tech specify specialization such as Mech, IT, etc)
9. Details of Marks Secured in Graduation & above
(Candidates who have not completed their graduation (i.e. appearing candidates)
need not apply; their application will not be accepted)

Examination Passed Name Name of Subjects Semester /Year wise Marks secured
graduation/Post of the University (Main
graduation or any other college Subjects
Semester/year Max. Marks % of
Qualification including
Marks obtained Marks
Electives)
1
2
3
4
5
6
7
8
Total
10. Appeared/ Did not appeared in earlier for Navy/ Army/ Air Force: Yes/ No
(If yes- Give details)
11. List of documents attached:a)………………b)………………c)……………….

DECLARATION
12. I, hereby, declare that I am unmarried male, governed by nationality conditions as laid
down by the Govt of India and have been debarred from appearing at any examination
nor have I, ever been arrested/ prosecuted and convicted by a criminal court or involved
in any other case registered by the police
13. I, herby, solemnly declare that all the statements made in the above application are true
and correct to the best of my knowledge and belief.
14. I fully understand that in the event of any information being found false or incorrect,
appropriate action can be taken against me.

Place:………………………….
Date:………………………….. Signature of the Applicant:……………
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