APPLICATION FOR 79 AEC (MEN) /51 SSC(MEN)/51 SSC(WOMEN)

COURSE COMMENCING IN JUL 2011

FOR OFFICE USE FOR AFSB USE

APPLICATION BRANCH AFSB CODE CHEST NO
NO. NO

1. NAME IN BLOCK CAPITALS AS IN MATRICULATION CERTIFICATE :

2. FATHERS NAME AS IN MATRICULATION CERTIFICATE :

3. PERMANENT ADDRESS WITH PIN CODE AND TELE NO , IF ANY :

PIN TELENO

4. PRESENT ADDRESS WITH PIN CODE AND TELE NO,IF ANY:(FOR

CORRESPONDENCE)

PIN TELE NO
5. CHOICE OF EKT CENTRE 1:__________________ CENTRE 2:_______________________

6. DATEOF BIRTH(DD/MM/YYYY)(As Per Matriculation Certificate):___________________

7. VISIBLE IDENTIFICATION MARK:______________________________________________

______________________________________________

8. MARITAL STATUS: SINGLE/MARRIED/WIDOWER/WIDOW/DIVORCEE____________

9. GENDER : MALE/ FEMALE ____________________________________________

10. E- MAIL _____________________________________________________________

11. Choice of Stream: Aeronautical Engg(Electronics)/ Aeronautical Engg(Mechanical)

(Strike out which is not applicable)

12. Technical Qualification (BE/B.TECH etc.) _________________________________________

(a) Engineering Discipline __________________________________________________________

(b) Subjects in Graduation ( Write subject codes) :

1._______ 2._______ 3._______ 4._______ 5.______ 6. ______ 7._______ 8._______

(c) Name of College and Place _______________________________________________________

(d) Name of University _____________________________________________________________

(e) Likely Date of Final Results in DD/MM/YYYY (For Appearing students) ________________

(f) SEMESTER / YEAR WISE MARKS :

SEMESTER MAXIMUM MARKS % OF SEMESTER/ MAXIMUM MARKS % OF

/YEAR MARKS OBTAINED MARKS YEAR MARKS OBTAINED MARKS

V
I
VI
II
VII
III
VIII
IV

TOTAL
 13. Choice of Commission{for MEN only}(PC/SSC): 1st Choice________ 2nd Choice _________

14. Appeared/ did not appear in SSB earlier for Army/ Navy/ Airforce/ Coast Guard.

15. NCC Air Wing (Sr. Div.) ‘C’ Certificate ______________________________YES/ NO.

DECLARATION

1. I hereby declare that all the statements made in the application are true to the best of my
knowledge and belief.

2. I have never been debared from appearing in any examination nor, have I ever been withdrawn
from Defence Training Establishments on disciplinary grounds, nor have I ever been arrested,
prosecuted or convicted by criminal court or involved in any other case registered by the police.

3. I undertake not to make any claim for compensation if at any stage of my selection, my
ineligibility for candidature is detected and my candidature is cancelled as a result thereof.

4. This is the only application submitted by me for 79 AEC(Men)/ 51 SSC(Men)/ 51 SSC(Women)

Courses.

5. Any willful misrepresentation of facts and concealment of information will result in the
cancellation of the candidature and may debar permanently or for a specified period from
applying for future courses.

6. Certified that I have read and understood the advertisement and fulfill the stipulated eligibility
criteria. I understand that my candidature is liable to be cancelled at any stage in case any
discrepancy is noticed.

Place : _____________________

Date : _____________________ LEFT THUMB IMPRESSION FOR MEN / SIGNATURE OF APPLICANT

RIGHT THUMB IMPRESSION FOR WOMEN