8/3/2019 Indian Navy SSC Officer
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APPLICATION FOR GRANT OF SHORT SERVICE COMMISSION
IN THE EDUCATION BRANCH OF THE INDIAN NAVY (MEN/ WOMEN
CANDIDATES)
1. Applying for
course________________Branch_________________
2. Name in BLOCK capital as in Matriculation certificate :-
3
.
3. Expanded Name if abbreviated in SI 2 above (abbreviated part
only)
4. Fathers Name:
5. Fathers Occupation/Designation:..
6. Permanent Address:
District
State PIN Tele
7. Correspondence Address
8. Nationality
9. Domicile :
10. Date of Birth :
(DD/MM/YYY)
11. Marital Status: Married Unmarried
12. Gender : Male Female
District
State PIN Mobile
Email
Regd No(for Official use only)
Paste Yourrecent
color
photograph(Do not
staple
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13. Details of marks secured in Graduation /Post Graduation
Exam
Passed
Semester/Year wise Marks secured
Graduation Semester/Year Marks Obtained Maximum Marks % of
Marks
Post
Graduation
Total Marks and Percentage :
14. If BE/ B Tech/ M.Tech, Specify stream eg. Mechanical/IT
Electronicsetc.
.
15. Name of college where studies and address
..
16. Name of University to which college / affiliated and
address.
17. Have you attended any SSB interview earlier.(If Yes ,give
details for all earlierattempts)
Service Type of Entry Name of SSB Month &Year of SSB
BatchNo.
Rsc/NotRec
Navy
Army
Air force
18. Details of service under Central/State Govt. if any.
(Candidates already in service should apply through proper
channel and obtain
NOC from the present employer)
DECLARATION
1. I, hereby, declare that I am unmarried male, governed by
nationality conditions as
laid down by the Govt of India and have been debarred from
appearing at anyexamination. I have neither been arrested/
prosecuted and convicted by a criminal
court or involved in any other case registered by the police
2. I, herby, solemnly declare that all the statements made in
the above application are
true and correct to the best of my knowledge and belief.
