Certificate of proficiency examinations list of contents application Forms
Ministry of Communications & Information Technology
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- DECLARATION
- FOR OFFICE USE ONLY
- Prov. GOC. Lic. No.--------------------------------- Issued on
Ministry of Communications & Information TechnologyWireless Planning & Coordination Wing FORM OF APPLICATION FOR ADMISSION TO EXAMINATION FOR AWARD OF Global Maritime Distress & Safety System (GMDSS) GENERAL OPERATOR’S(GOC) CERTIFICATE 1. Name of Applicant (in Block letters) : 2. Father’s Name :
4. Marks of Identification : 5. Date of Birth (Attach an attested copy of : School Leaving Certificate or Matriculation Certificate) 6. a. Are you a citizen of India by Birth and /or Domicile : b. If not, to which country you belong (attach attested copy of Passport) : 7. Whether copy of requisite Qualification Cerificate attached: (i) 10+2 certificate : No. Date OR (ii)COP/COC/COS :No. Date of expiry: 8. ( i ) Demand Drafts Number/Date/Amount : (ii) Issue Branch with Code No. : DECLARATIONI hereby solemnly declare that the foregoing facts are true and correct and nothing is false therein and nothing material has been concealed therefrom. I also agree that in case any information given by me herein before is found false at later date, the certificate and licence to operate, if granted, will be cancelled. I also certify that I shall maintain Secrecy of correspondence as required under the Rules. Place: Signature of the applicant Date: Name (in Block letters)
Date: (PRINCIPAL) 2
FOR OFFICE USE ONLYRoll Number allotted : Centre : NEW DELHI Date of Examination : Marks obtained : Part I ……………….. Part II ………………. Result : Passed/Failed (Witness Signature) Signature of Examination-in-Charge Certificate/Licence Number Issued Validity of Certificate/Licence
Signature of AWA to Govt. of India 3 ATTENDANCE SHEET CUM RESULT SHEET GMDSS GOC LICENCE NO.: PHOTOGRAPH DATE OF ISSUE : AWA TO GOI
(i) Certificate No.: _________________ Dated: _____________ (ii) Marks Shee No: _________________ (b) IN CASE OF COC, COP, COS Licence No. _________________valid till: ____________ 9. PERMANENT ADDRESS ___________________________________________________ (WITH PIN CODE) ___________________________________________________ 10. CONTACT TEL. NO./E-MAIL : ___________________________________________ CENTRE : ROLL NO.: Signature of the candidate Date : Marks Result Signature of the Examiner : Exam-I-C/Examiner PART:I (Written) : PART: II (Sec.A) : (Commercial Wkg.) : PART: II Practical : Examiner DGS : Examiner, WPC : Exam.-in-Charge : Prov. GOC. Lic. No.--------------------------------- Issued on:---------------------------------------Note: Staple two identical colour photographs with name, on reverse side with this form and paste one above. Necessary undertaking wherever necessary must be attached by provisionally admitted candidates. 4 DECLARATION I hereby solemnly declare that the foregoing facts are true and correct and nothing is false therein and nothing has been concealed therefrom. I also agree that in case any information given by me herein before is found false at a later date, the certificate and licence to operate, if granted, will be cancelled. I also certify that I shall maintain secrecy of correspondence as required under the Rules.
Place Signature of the Applicant Date Name (in block letters) 1. Certified that the particulars furnished by the candidate Shri__________________________________ above are true to the best of my knowledge and belief.
Signature (…………………………….) Name Place: Chief Course Coordinator GMDSS Name of the Institute Date: Stamp of the Institute : FOR FOREIGN NATIONALS PERSONAL PARATICULARS OF APPLICANT (To be submitted in Six copies)
(B) NAME: PLACE OF BIRTH: 2. DATE OF BIRTH : 3. FATHER’S NAME : 4 (a) PRESENT FULL ADDRESS : PERMANENT ADDRESS : (IN INDIA) CITY : CITY : STATE : STATE : 5 (a) PASSPORT NO. : DATE : VALID UPTO :
7.(a) DO YOU BELONG TO DEFENCE FORCES : OF YOUR COUNTRY ?
I hereby solemnly declare that the foregoing facts are true and correct and nothing is false therein and nothing material has been concealed therefrom. I also agree that in case any information given by me is found false at a later, the certificate and licence to operate, if granted, will be cancelled. Name & Signature of Applicant Place :
Dated : Form of application for Renewal of COP Licence (Radio Telegraphy/Telephony In Aeronautical/Maritime Services) C.O.P.- 23 Directory: yahoo site admin -> assets -> docs docs -> 12 Step Retreats For Everyone in Twelve Step Recovery Ratner Fellowship docs -> 12 Step Retreats For Everyone in Twelve Step Recovery Ratner Fellowship docs -> Central Government is expected to ask the seventh pay commission to consider merging 50% dearness allowance docs -> Newsletter of the gfwc of Holden Beach P. O. Box 902, Supply, nc 28462 Volume 8, Issue 5, September 10, 2013 Julie Wolfe, President Judy Brock, Editor docs -> Richard M. Dishman docs -> John Cane Curriculum Vitae docs -> Novice Junior Bush Ballad docs -> Chemical Corps csm/sgm roster docs -> Real time project docs -> Outfitter/Client Contract Download 280.42 Kb. Share with your friends:
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