AME AME AME AME AME

Registration Temp Id: E-T2019/2921 E-T2019/2921

APPLICATION FOR ALLOTMENT OF COMPUTER NUMBER FOR APPEARING DGCA INDIA CA

IN AME LICENCE EXAMINATION Form 19-07

GOVERNMENT OF INDIA
DIRECTORATE GENERAL OF CIVIL AVIATION
CENTRAL EXAMINATION ORGANISATION

FOR OFFICE USE ONLY SIGN OF OFFICER

E-

1. PERSONAL DETAILS

1.1. Name ASHWINI YOGESHWAR MATE

1.2. Gender FEMALE

1.3. Date of Birth 07-08-1990

1.4. Mother's Name LATA MATE

1.5. Father's Name YOGESHWAR MATE

1.6. Email ID ashu78910mate@gmail.com

1.7. Nationality INDIA

1.8. Mobile Number XXXXXX8869

2. Study Details

Do you have AIU/ equivalent education qualification NO

certificate?

Have you studied in Foreign University, situated in India NO

or Abroad?

3. Address

Correspondence Address Permanent Address

123 welcome society godhani road zingabai takli nagpur 123 welcome society godhani road zingabai takli nagpur
nagpur Maharashtra PIN-440030 India nagpur Maharashtra PIN-440030 India

4. Education

Level Degree / Board / University Duration Year of Percentage

Diploma (In Year) Passing

10th - Maharashtra State Board of Secondary and 1 2005 71.86

Higher Secondary Education

10+2 with PCM - Maharashtra State Board of Secondary and 1 2007 70.50
Higher Secondary Education

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Registration Temp Id: E-T2019/2921 E-T2019/2921

5. 10+2 Details

Subject Marks Maximum Board/ University

Obtained Marks

Physics 79 100 Maharashtra State Board of Secondary and Higher Secondary

Education

Chemistry 62 100 Maharashtra State Board of Secondary and Higher Secondary

Education

Maths 62 100 Maharashtra State Board of Secondary and Higher Secondary

Education

6. Applicant Type Details

GENERAL

7. Aircraft Maintenance Experience

1 Years 8 Months

Types of Org / AME Institute From To Period (in mths)

Aircraft/Engines/System

Learjet 25/B2/CJ610 WINGSSS COLLEGE 10-10-2017 03-08-2019 22

TURBOJET ENGINE OF AVIATION
TECHNOLOGY

8. Documents Uploaded and to be enclosed

S.No. Doc.No. Document Name Tick Mark DGCA Remark

1 - Applicant Photograph

2 - Applicant Signature

3 1 Date of Birth Proof

4 2 Xth Marksheet

5 3 Board Verification Certificate for Xth

Qualification

6 4 XIIth / Technical Diploma Marksheet

7 5 Board Verification Certificate for XIIth/

Diploma/Equivalent Qualification

8 6 UID Aadhar Card

9 7 Copy of Proof of Permanent Address

10 8 Experience Certi From 2017-10-10 To 2019-

08-03

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Registration Temp Id: E-T2019/2921 E-T2019/2921

9. Declaration

I hereby declare that the information provided in this form is correct in every respect to the best of my
❏ knowledge and belief and that nothing has been concealed or withheld by me, I understand that if any
of my particulars/enteries are found false or incorrect before or after the examination, my candidature
shall be rejected and further action can be taken against me by DGCA as deemed fit. Further, I
understand that unutilized fees paid(if any), for previous session(s), will not be adjusted, carried
forward for future examination.

It is an Offence to make, with intent to deceive, any false representation for the purpose of procurring
❏ the grant, issue, renewal or valiation of any certificate, license, approval, permission or other
document. Persons doing so render themselves liable, on summary conviction, to a fine of one lakh
rupees and / or imprisonment for a term not exceeding three months. Further, if renders the person
permanently ineligible to have an Aircraft Maintainance Engineer's License.

I declare that I have read and understood the above declaration.

❏
DATE SIGNATURE

PLACE NAME

10. CERTIFICATION BY COMPETENT AUTHORITY

This is to certify that all the above particulars furnished by ASHWINI YOGESHWAR MATE
have been verified by me and found to be correct.
Paste photograph as
uploaded and get it cross
attested by competent
authority.

Date: Signature:

Place: Name:

Designation:
(STAMP OF THE AUTH. SIGNATORY)

This certificate to be attested by QM/ DyQM/ TM/ CI/ DyCI. Chief Engineering Officer in case of serving Defence personnel.

Gazetted officer / Notary Public for PRIVATE unemployed candidate.

* Signature & stamp of the competent authority should partly cover the pasted photograph.

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