:: ONLINE APPLICATION :: http://www.joinindiancoastguard.gov.in/Report.aspx?qskFgeYo+6R6byF...

INDIAN COAST GUARD

ONLINE APPLICATION FORM
Application No. : 318/656953 Roll No. :
Affix recent
(1) Name of the post applied for : Navik General Duty
passport size
(2) colour Photo
Centre at which you wish to appear for Test :-
Date and Time of Reporting at Centre :

Priority Centre Name Full Address of the Centre

INDIAN COAST GUARD ENCLAVE, BEHIND
VISHAKAPATNAM PORT HIGH SCHOOL, MALKAPURAM PO,
1
- VZ VISHAKHAPATNAM, ANDHRA PRADESH - 530
011

(3) Name of the candidate (as in Matriculation)

SUGAMANCHI VENKATA SAI Gender : Male
(4) Current postal address:
GAYAMVARI PALLI(VILLAGE), BADUGULERU(POST), KANIGIRI(MANDAL),
PRAKASAM(DISTRICT), CITY: KANIGIRI, STATE: ANDHRA PRADESH/SEEMANDRA,
DISTRICT : PRAKASAM, PIN : 523245
(5) Permanent address:
GAYAMVARI PALLI(VILLAGE), BADUGULERU(POST), KANIGIRI(MANDAL),
PRAKASAM(DISTRICT), CITY: KANIGIRI, STATE: ANDHRA PRADESH/SEEMANDRA,
DISTRICT : PRAKASAM, PIN : 523245
(6) E-mail ID : sugamanchivenkatasai@gmail.com Mobile No : +918466995124
(7) Mother's name : SUGAMANCHI VENKATA KUMARI (8) Aadhaar No.
(9) Father's name : SUGAMANCHI CHINNA CHOWDAIAH
(10) Category OBC (11) Date of Birth 12 May 1999 (12) Nationality : Indian
(13) Qualification
Compl. Compl. Year of
Qualification Board/Institution AggrPercent
Subject Mark Passing
BOARD OF
INTERMEDIATE
12th 75.2 Physics 116 2016
EDUCATION (ANDHRA
PRADESH)
Maths 120 2016
(14) Knowledge of Swimming : NO
(15) Proficiency in sports, National Level (attach photocopies of certificate) : NO
(16) NCC certificate obtained (attach photocopy of certificate, if yes) : --NA--
(17) Marital Status : Unmarried
(18) Is Wards of Coast Guard uniform personnel deceased while in service : NO

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:: ONLINE APPLICATION :: http://www.joinindiancoastguard.gov.in/Report.aspx?qskFgeYo+6R6byF...

(19) Is your father serving /retired from Defence : NO

(20) Is Service Personnel : NO
(21) Declaration :
I, hearby solemnly declare that all the statements made in the above application are true and correct to
the best of my knowledge and belief. I fully understand that in the event of any information being found
false or incorrect, appropriate action can be taken against me.
Place : NUZVID Signature :
Name of the Applicant :
Date : 01/01/2018 SUGAMANCHI VENKATA
SAI

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