Online Application Form

Course Applied for * :

Name * :

Picture upload * :[Minimum Image width 100px and Maximum Image size 1MB is allowed]

Address for Correspondence * :

Pin * :

Phone Number :

Mobile Number * :

E-Mail ID * :

Date of Birth * :

Sex * :

Male

Female

Passport Details :

No:

Issued by country:

Validity from:

Validity to:

Nominated authority :

Name:

Address:

Phone Number:

E-Mail ID *:

FAX No:

Emergency Contact Details :

Bio data :[Only pdf,excel,doc file is allowed and file size should not be more than 1MB]

Transaction Details:

Amount

Transaction Id

Date

Certificates:

STCW-II/I OOW (Deck) or equivalent

Radar and ARPA course certificate holders

GMDSS ROC or VTS VHF Radio course certificate holders

2nd Met Certificate of competency (Minimum sailing experience 0f 24 months as 2nd Met or above)