Merchant Navy Medical

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MERCHANT NAVY CENTRE

SOLUTION FOR MERCHANT NAVY CAREER GUIDANCE

Contact us Mobile No. 092********/097********

Website:www.merchantnavycentre.com

APPLICATION FORM TO JOIN MERCHANT NAVY

Application.

PERSONAL DETAILS

1 NAME OF THE APPLICANT : PRADIP KUMAR CHOURASIA

2 DATE OF BIRTH : Age :22

4 NATIONALITY : INDIAN

5 PERMANENT ADDRESS WITH : PRADIP KUMAR CHOURASIA, 2/2 TOPSIA ROAD

(H.No. / Name of the KOLKATA, WEST BENGAL-700039, INDIA

Premises / Street / Area /

City, District, State and

Pin Code)

(STD Code) - Tel. No. :089********

Email ID:

pdip1808@g

mail.com

6 CURRENT ADDRESS WITH : PRADIP KUMAR CHOURASIA, 2/2 TOPSIA ROAD

(H.No. / Name of the KOLKATA, WEST BENGAL-700039, INDIA

Premises / Street / Area /

City, District, State and

Pin Code)

(STD Code) - Tel. No. :089********

7 FATHER'S OCCUPATION : BUSINESS MAN

8 MOTHER'S NAME : URMILA DEVI

9 PASSPORT NO. : NA

10 RELIGION : HINDU.

11 EDUCATIONAL QUALIFICATIONS

Sl. NAME OF THE QUALIFYING EXAM YEAR OF BOARD / SUBJECTS % OBTAINED

No. PASSING UNIVERSIT

A XTH STD 2008 WBBSE ALL ENG %56

SUBJECT

B XIITH STD 2010 WBCHSE COMMERCE PCM %

C DIPLOMA (IT) 2012 JHARKHAND DIESEL

MECHANIC

D GRADUATION NA NA NA NA

E DEGREE (BTECH/BE/) NA NA NA NA

12 MEDICAL / PHYSICAL DETAILS

A HEIGHT (IN CMS) : 154 CM

B DO YOU USE SPECTICLES / : NO IF YES

CONTACT LENS POWER OF

EYE SIGHT

C COLOR OF HAIR : BLACK COLOR OF

EYES

D VISIBLE IDENTIFICATION MARKS : A CUT MARK ON RIGHT HAND SIDE TOP MIDDLE

FINGER

13 FAMILY BACKGROUND

GIVE BRIEF DISCRIPTION ABOUT FAMILY BACKGROUND/ INCOME SOURCE/FAMILY INCOME

WITH A FUN LOVING FAMILY, FATHER INCOME 50000 PER ANNUM

INSTRUCTIONS TO APPLICANTS:

To get resister with MNC Complete Application form and send by SCAN COPY E-

MAIL Id: - ****************@*****.***. We will assess your form and send

you detail about the course you are eligible with further detail to Join

Merchant Navy.

DECLARATION :

I hereby declare that all personal information and other particulars

furnished by me in the application form are true and correct to the best of

my knowledge. I have been informed of the course fee and the mode of

payment. In the event that any information furnished by me in this form is

found to be false or incorrect, Merchant Navy Centre reserves the right to

suspend or expel me from the course and forfeit my fee.

In the event that I willfully and/or prematurely withdraw my name from the

course, I understand that I shall have no right to fee refund.

I affirm that I have read and understood the Terms and Acceptance and Code

of Conduct. I agree to abide by the rules and regulation, maintain

discipline and conduct myself in a proper manner . In the event of my

breach of the acceptance terms and conditions for this course, Merchant

Navy Centre reserves the right to discharge me from to the disciplinary

committee and I shall agree by the decision s of the committee.

I also understand that during my training with Merchant Navy Centre, I

shall abide by the laws, rules and regulations as set.

Also to inform that Merchant Navy Center and any of its employ is not a

Recruitment Agency/agent and Job provider we are maritime consultant.

All disputes to be settled at New Delhi Jurisdiction only.

Place : KOLKATA

Date : 08-08-2015 Signature Of Applicant

:Pradip Chourasia

Signature Of Parent/Guardian: B. P. Chourasia

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