Application Form
 
Basic Details
COURSE OFFERED
Name of the Applicant
Email
Father's Name
Present Address
Address  
Contact No
Permanent Address
Address
Contact No
   
 
ACADEMIC QUALIFICATION
Education Institue Name Board Year Of Passing % of marks
10th STD    
12th STD      
10+2+3      
Technical Qualification, if any
Examination Institue Name Year Of Passing % of marks Class
         
     
         
 
   
 
Other Details
Date of Birth  
Father's Occupation  
Marital Status
Passport No
Place Of Issue  
CDC NO INDIAN  
Date Of Issue  
Issued at  
Height  
Weight  
Complexion  
Place of Birh  
Monthly Income  
Nationality  
Date Of Issue  
Date of Expiry  
CDC Others  
Date of Expiry  
   
Eye Vision  
Colour of eyes  
Identification Mark  
 
 
LANGUAGE KNOWN
LANGUAGE BENGALI HINDI ENGLISH
Write      
Read    
Speak      
   
  Please make a selection. I hereby declare that, all statements furnished in the application are true and to the best of my knowledge and belief. I understand that in the event of any information furnished by me is found to be false or incorrect, my candidature/admission will be liable for rejection. Moreover, I understand, the institute has no responsibility towards employment on completion of training. I also understand the training institute will, in no way, be responsible for any accident or injury suffered by the undersigned during the course of training at Jharkhand Maritime Education Pvt. Ltd. , Ranchi.
 
Date  
Place  
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