Regd. No....................

(For Official use only)

APPLICATION FORMAT
APPLICATION FOR GRANT OF PERMANENT COMMISSION
IN THE INDIAN NAVY FOR NAVAL ARMAMENT INSPECTION CADRE OF
THE EXECUTIVE BRANCH - JAN 2011 COURSE

INSTRUCTIONS FOR FILLING UP THE FORM

1. Application form to be filled in English only in block capitals.

2. Strike out whatever is not applicable.
3. Attach attested copy of class Tenth certificate for date of birth verification.
4. Attach attested copies of all other educational certificates.
5. Application and enclosures to be properly tagged together by thread or stapled to avoid any loss.
6. Candidate submitting more than one application will be disqualified.

LAST DATE FOR RECEIPT OF APPLICATION 21 AUG 2010

1. Candidate’s Name in Block Capital as in Matriculation Certificate:-

Affix self
Attested
2. Expand full name if abbreviated in Serial 1 above:- recent
Passport
size colour
3. Date of Birth (DD/MM/YY) photograph

(As per Matric /Equivalent Certificate: Should be between 02 Jan 1986 & 01 Jul 1991.
Both dates inclusive)
4. Father’s Name:-

5. Father’s Occupation/Designation…………………………………………….
6. Correspondence Address:-

PIN Tel. No.

Mob. E-mail
7. Permanent Address:-

PIN
8. Marital Status: Married Unmarried
9. Nationality 10. State

11. Educational Details:-

(a) Educational Qualification ……………………... Aggregate. Percentage………………
(BE/B Tech & Stream e.g. Mechanical/Electrical/Electronic etc.)
(b) Name of the College along with Address from Where Studied
………..………………………………………………………………………………………….
(c) Name of University along with Address to which college /institution is affiliated
………………..………………………………………………………………………………….
12. Details of Marks Secured in Graduation & above: - (Candidate who have not
completed their BE/B. Tech (i.e. candidates appearing for semester exams need not
apply. Their application will not be accepted)

Examination Subjects Semester /Year wise Marks secured

Passed Graduation (Main Semester/ Maximum Marks % of Marks
/ Post Graduation subjects Year marks obtained
or any other including
Qualification Electives)
Graduation 1
2
3
4
5
6
7
8
Total: ……… ……… ………
Post Graduation
Other Qualification
(Please attach extra sheet, if necessary)
(Attested copies of mark sheet of each semester/year must be attached. In case evaluation
is in grades, certified equivalent marks to be indicated).

13. Have you attended any other SSB interview earlier? If yes, indicate (for all the earlier
attempts):- Navy Army Air Force
(a) Type of Entry ________ _________ _________
(b) Name and Station of SSB ________ _________ _________
(c) Batch No. ________ _________ _________
(d) Month and Year of Interview ________ _________ _________
(e) Whether Recommended ________ _________ _________

14. Details of service under Central/State Govt., if any ……………………………………….

(Candidate already in service should apply through proper channel and obtain NOC
from the present employer).
15. List of documents attached:-
(a) ………………………………………….. (b) ………………………………………..
(c) ………………………………………….. (d) ………………………………………..

DECLARATION

16. I hereby declare that I am unmarried male/female governed by nationality conditions as

laid down by the Govt. of India and have never been debarred from appearing at any
examination. I have neither been arrested/prosecuted and convicted by a criminal court or
involved in any other case registered by the Police.
17. I hereby solemnly declare that all the statements made in the above application are true
and correct to the best of my knowledge and belief.
18. I fully understand that in the event of any information being found false or incorrect,
appropriate action can be taken against me.
Place : ........................ Signature..................................
Date : .......................... Name of the Applicant.............