Enquiry Form

Course Applied

PERSONAL PARTICULARS

*Name

(As in your school certificate)

*Date of Birth

(Format : dd/mm/yyyy Example: 25/03/1982)

Age

*Permanent Address

(where now residing)

*Email ID

(enter most used Email ID)

Telephone No.

(With STD Code)

or Contact no

Height(Cms)

Weight(Kgs)

Food

Married

EDUCATION

*SECONDARY /
10th STANDARD

English		Total		Examing Board	Total %
Marks	Out of	Marks	Out of

SENIOR SECONDARY /
10+2 STANDARD

Marks Obtained				Examing Board	PCM Aggregate %	Total %
Physics	Chemistry	Maths	English

DIPLOMA

1st Year %	2nd Year %	3rd Year %	Total %

DEGREE

1st Sem %	2nd Sem %	3rd Sem %	4th Sem %	5th Sem %	6th Sem %	7th Sem %	8th Sem %	Total %

LOCAL ADDRESS

Local Address

Telephone No

(With STD Code)

or Contact No:

FAMILY BACKGROUND

Father's full name

Profession

(Specify Clearly)

Mother's full name

Profession

(Specify Clearly)

No. of Brothers

Sisters

NEXT OF KIN

Name

Relationship

Address

Telephone No

(With STD Code)

OTHER-ACTIVITIES (Hobbies)

AWARDS/PRIZES/MERIT/NCC/ACHIEVEMENTS

SKILLS

Can you Swim?

Meters.

Do you have good command over written/spoken english?

PASSPORT DETAILS

Passport No.

Issued At

Valid Upto

Nationality

Do you have any close relatives in merchant navy? (give details)

DECLARATION

I certify that the information contained in this Enquiry form is true to the best of my knowledge and belief. I have not withheld any material/information that would effect my application/selection. Should any information be found incorrect, I understand that the board of OSMS reserves that rights to terminate my training without any refund of my fees and the board of OSMS will not be liable to compensate me in any way.
I am aware that I may be subjected to urine, drug, medical tests for selection and at any time during my training, and if urine/drug test found positive or I am found medically unfit, my training may be termiinated and i agree to bear all expenses towards my training/treatment as the OSMS board may deem it.
I agree to produce the originals of all my certificates at the time of interview and whenever required.
I have read and understood the contents of the prospectus and agree to abide by all the terms and conditions contained threin.
I am aware and agree that after selection and joining OSMS should I withdraw for any reason, no money will be refunded.