APPLICATION FORM FOR ARTIFICER APPRENTICE 138 BATCH

(UNMARRIED MALE CANDIDATES ONLY)

FOR INDIAN NAVY OFFICE USE ONLY

Code No:

For Office use only:

Application No:
(Affix Photograph)

VALID / INVALID
A13812038714N
1. PERSONAL PARTICULARS AS IN MATRICULATION CERTIFICATE:
NAME:

ASHOK KUMAR

DATE OF BIRTH:

1997/07/01

FATHER'S NAME:

OM PRAKASH

PERCENTAGE (10+2):

90.8

2.NATIONALITY:

INDIAN

5. ADDRESS:

3.MARITIAL STATUS:

Unmarried

4.EMAIL: ashok19840@gmail.com

PERMANENT

PRESENT

VILL KEDARIPUR PO BIRAMPURDISTT LAKHIMPUR KHERI

VILL KEDARIPUR PO BIRAMPURDISTT LAKHIMPUR KHERI

DISTRICT

LAKHIMPUR KHERI

LAKHIMPUR KHERI

STATE

Uttar Pradesh

Uttar Pradesh

PINCODE

262727

262727

--NA--

8447058065

TELEPHONE
MOBILE

6. EDUCATION PARTICULARS(HIGHLIGHTED SUBJECTS(10+2)):-Compulsory- Physics and Maths Optional- Chemistry

Year of Passing

Authority Conducting Exam

2014

STATE BOARD

State from which Exam Passed Serial No. of Certificate Marks obtained

Uttar Pradesh

2356349

7. NCC Certificate
8. HAVE YOU EVER BEEN ENROLLED IN ARMED FORCES BEFORE?
9. HAVE YOU BEEN DISCHARGED FROM ARMED FORCES BEFORE?
10. DO YOU VOLUNTEER FOR SUBMARINE SPECIALISATION?
11. VISIBLE IDENTIFICATION MARKS (AT LEAST TWO):(a) RIGHT FOOT CUT MARK

Total marks

Percentage

500

90.8

454
NO
NO
NO
YES

(b) LEFT HAND SECOND FINGER CUT MARK

DECLARATION
1. I hereby declare that all the statements made in the application are true to the best of my knowledge and belief and the application has been filled
up by me.
2. I have never been debarred from appearing in any examination nor, have I ever been withdrawan from Defence Training Establishments on
disciplinary grounds, nor have I ever been arrested, prosecuted or convicted by criminal court or involved in any other case registered by the police. I
have not submitted more than one application for this batch.
3. I undertake not to make any claim for compensation if at any stage of selection, ineligibility for my candidature is detected and my candidature is
cancelled as a result thereof.
4. Any wilful misrepresentation of facts and concealment of information will result in the cancellation of the candidature and may debar me
permanently or for a specific period from applying for future examinations.

Place ___________
Date _____________

Signature of Parent

Signature of Applicant

IDENTIFICATION FORM
Name

ASHOK KUMAR

Father's name OM PRAKASH

Visible Identification Marks (at least two):(a) RIGHT FOOT CUT MARK
(a) LEFT HAND SECOND FINGER CUT MARK

Application No. A13812038714N

Date of Birth

1997/07/01
(Affix Photograph)
Signature of Applicant

NOTE:
Please forward the print out of this application duly signed to the address mentioned in the advertisement along with relevant documents by ordinary
post.
December 20, 2014, 8:20 pm