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APPLICATION FORM

APPLICANT'S PERSONAL DETAILS
Name :-
Date of Birth :- Nationality :-
Birth Place / Country Gender :-
Permanent Address :
Telephone(Home) :- Mobile :-
Email ID :-
 
APPLICANT'S FAMILY DETAILS
Name RelationshipDate of BirthOccupation
 
APPLICANT'S TRAVEL DOCUMENTS DETAILS
Passport Number :- Date of Issue :-
Date of Expiry :- Place of Issue:-
Origin :-
 
APPLICANT'S EDUCATIONAL DETAILS
Period of Study Name of School/CollegeQualification ObtainedPCMENGLISHTOTAL
 
APPLICANT'S PERSONAL INFORMATION
Hobbies :- Sports :-
Other Activities:- Awards & Prizes
 
APPLICANT'S DECLARATION
- Have you ever been refused ‘Entry’ into or ‘Deported’ from any country?
- Have you ever been convicted in court of Law in any country?
- Have you ever been prohibited from entering or refuses visa for any country”
- Have you ever entered any country using a different name or passport?
- Have you ever been convicted for a drug related offence?
 

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, Nimbus Maritime Academy 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 manner befitting a cadet of NMA. In the event of my breach of the acceptance terms and conditions for this course, Nimbus Maritime Academy 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 Nimbus Maritime Academy, I shall abide by the laws, rules and regulations as set.

 
Name :- Date :- Place:-


PAYMENT OPTION FOR APPLICATION FORM **

Please deposit the amount Rs-3500/- (Rs. Three Thousand Five Hundred only) to the following account.

“NIMBUS MARITIME EDUCATION & SEAMEN WELFARE FOUNDATION”

ICICI BANK
MULUND BRANCH, MUMBAI-400 080

A/C NO : 623805029268

RTGS/NEFT/IFSC CODE : ICIC0006238


** Application without fee will be rejected.