(UNMARRIED MALE CANDIDATES ONLY) APPLICATION FORM FOR SENIOR SECONDARY RECRUIT (02/2012) BATCH FOR INDIAN NAVY

OFFICE USE ONLY CODE NO. VALIDIT Y STATUS Valid In valid Application No.

Paste your recent colour photograph (Do not staple)

1. NAME IN BLOCK CAPITALS AS IN MATRICULATION CERTIFICATE:2. FATHERS NAME AS IN MATRICULATION CERTIFICATE:3. Date of Birth (DD/MM/YY) 5. 4. Nationality : ________________

PERMANENT ADDRESS WITH PINCODE. TELE NO, E-MAIL ID IF ANY:DISTRICT

STATE

TELE EMAIL 6. PRESENT ADDRESS WITH PIN CODE. TELE NO, IF ANY:DISTRICT STATE TELE

PIN

PIN

7. Educational Particulars(10+2):- Highlight subjects(10+2)Physics Chemistry Maths Biology Computer Sc Year of Authority State from Serial No. of Certificate Marks obtained/ Percentage Passing conducting total marks which Exam Exam Passed

/
8. MARITAL STATUS: Married Unmarried 9. Have you ever been enrolled in armed forces before? 10. Have you been discharged from armed forces before? Yes No 11. Visible Identification Marks (at least two):(a) (b) DECLARATION

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Yes No

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 I have never been debarred from appearing in any examination nor, have I ever been withdrawn from Defence Training Establishments on disciplinary grounds, nor have I ever been arrested, prosecuted or convicted by criminal court or involved in any other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 willful misrepresentation of facts and concealment of information will result in the cancellation of the candidature and may debar me permanently or for a specified period from applying for future examinations

Place:............................... Date : ........................ ...... Signature of Parent Signature of Applicant

List of Documents: The following documents are to be attached by punching and tying firmly with a strong thread to the application in the sequence below:Attested copy of (a) Matriculation certificate.( for verification of Date of Birth) (b) 10+2 certificate (c) 10+2 mark sheet (d) Domicile certificate. Two self-addressed envelops of size 22 x 10 cms with Rs 10/- stamp affixed on one envelope. Note: - All the above certificates are to be attested by Gazetted Officer (The name of attesting officer should be legible).

........................................................................................................................................................................................................................ IDENTIFICATION FORM Paste your Application No. Date of Birth (DD/MM/YY) recent Name coloured photograph (Do not Fathers name staple) Visible Identification Marks (at least two):(a) (b)
SIGNATURE OF APPLICANT:

INSTRUCTIONS FOR FILLING UP APPLICATION FORM Application Form: The application is to be submitted on A4 size white copier paper which also available on website www.nausena-bharti.nic.in. Candidates forwarding application on any other format and candidates who send more than one application for the same entry will be rejected Envelops: Domicile state, type of entry and percentage of marks in 10+2 board examination is to be clearly written on top of the envelope containing the application. Envelopes should be of brown colour. Example: SSR 02/2012 MAHARASHTRA 68.7 % (10+2). List of Documents: The documents mentioned in the application form are to be punched and tied firmly with a strong thread to the application in the correct sequence. Photographs: THE PHOTOGRAPH SOULD BE CLEAR AND GOOD QUALITY WITH BLUE BACKGROUND. Application received without photographs or not in the specified format will be rejected. APPLICATIONS All applications are to be addressed to Post Boxes as given below:Candidate address (state) Delhi, Himachal Pradesh Application to addressed to be Candidate address (state) Application to addressed to be

Post Box No 476, Assam, Arunachal Pradesh, Post Box No 11810 Gole Dak Khana, Meghalaya Mizoram, Delhi Cant GPO, Nagaland Sikkim, Tripura, New Delhi -110 010 Manipur ,J & K Andaman New Delhi -110 001 Nicobar Islands, Carnicobar Kerala UT of Lakshdeep & Minicoy Post Box No 02 Lodhi Road New Delhi -110 003 Uttar Pradesh Post Box No 5270 Chanakyapuri PO New Delhi -110 021

West Bengal

Orissa Karnataka

Post Box No 4921 Safdarjung Enclave PO New Delhi -110 029 Post Box No 5011 RK Puram Sector V New Delhi -110 022

Andhra Pradesh Tamil Nadu Post Box No 488 UT of Pondicherry Gole Dak Khana, GPO New Delhi -110 001 Maharashtra, Goa Gujarat and UT of Daman, Diu and Nagar Haveli Haryana Post Box No 7001 IPHO New Delhi -110 002 Post Box No 4844 Sarojani Nagar PO New Delhi -110 023 Post Box No 10925 RK Puram ,Main PO, New Delhi 110066

Rajasthan

Punjab &UT of Post Box No 7215 Chandigarh IPHO Uttarakhand New Delhi -110 002 Madhya Pradesh Chatisgarh Post Box No. 8860 Vasant Vihar, New Delhi -57

Bihar, Jharkhand

Note: For administrative reasons, Navy may allot any suitable centre. Further, Navy will not be responsible for any postal delay/loss of any documents during transit.