DGCA INDIA

APPLICATION FOR ONLINE REGISTRATION

CA FORM 19-07A

Government of India
Director General of Civil Aviation, Central Examination Organisation

COMPUTER NUMBER : E-07040273

1. PERSONAL DETAILS

Name Mr Bhagwan Singh Negi

Gender Male
Paste Recent coloured
Date of Birth 18-11-1985 Passport
size Photograph and
Signature below with black
Father's Name Sh Karam Singh Negi ink
Mother's Name Smt indira devi

Email Address bhaskernegi@gmail.com

Category GENERAL
Nationality INDIA
UIDAI Number
(Adhar No.)

Passport Date of Date of AIU Equivalent Security

Country Place of Issue
Number Issue Expiry Educational Clearance
H5233035 INDIA 2009-05-11 2019-05-10 DEHRADOON

Correspondence Address Permanent Address

FRIEND COLONY FRIEND COLONY

tally haldwani NEAR TRANSPORT NAGAR tally haldwani NEAR TRANSPORT NAGAR
HALDAWANI CITY HALDAWANI CITY
Uttarakhand 263139 Uttarakhand 263139
 2. QUALIFICATION DETAILS
Level Degree / Diploma Board/ University Duration Year of Passing Percentage

10 + 2 INTERMEDIATE Board of School Education Uttarakhand 2.0 2003 63.60

B.Sc B. Sc. pcm KUMAUN UNIVERSITY 3.0 2006 66.60

10+2 MARKS DETAILS

Subject Marks Obtained Maximum Marks Board/University
Physics 71.0 100.0 Board of School Education Uttarakhand
Chemistry 59.0 100.0 Board of School Education Uttarakhand
Maths 78.0 100.0 Board of School Education Uttarakhand
English 51.0 100.0 Board of School Education Uttarakhand
Other GENERAL HINDI 59.0 100.0 Board of School Education Uttarakhand

3. APPLICANT TYPE : GENERAL

Name of Organization / Approved institutes Stream Category
OTHERS Mechanical A1,A2,A3,A4,B1.1,B1.2,B1.3,B1.4

4. AIRCRAFT MAINTENANCE EXPERIENCE

Total Experience: 11 Years and 4 Months
DETAILS OF AIRCRAFT MAINTAINENCE EXPERIENCE
Type of Aircraft/ engines/system Organisation/Approved AME Area of Work Major/Line/ From To Period
Institute Shop/AME Institute (in months)
KINGAIR B200/PWC PT6A-42/ SARAYA AVIATION NEW DELHI MALOR/LINE 05-04-2009 05-10-2009 6
KINGAIR B200/PWC PT6A-42/ SAPL NEW DELHI MAJOR /LINE 01-11-2009 30-03-2015 64
KINGAIR B200/PWC PT6A-42/ AMMROC ABUDHABI UAE MAJOR/LINE 03-06-2015 14-10-2017 28

5. DOCUMENTS UPLOADED AND TO BE ENCLOSED

Enclosure No. Document Name Tick Mark DGCA Remark
1 Applicant Photograph
2 Copy of BAMEC / Licence
3 Applicant Signature
4 Required Certificate 1
5 Xth Certificate/Date of Birth Certificate
6 XIIth / Technical Diploma Marksheet
7 XIIth / Diploma pass Certificate
8 Board Verification Certificate for Xth qualification
9 Board verification certificate for XIIth/ Diploma/Equivalent qualifiaction
10 Copy of Proof of Permanent Address
11 Experience Certificate
12 Association of Indian University Certificate
13 Copy of Passport
14 Branch / Trade certificate
15 UID Aadhar Card
 6. DECLARATION
I hereby declare that the information provided in this form is correct in every respect to the best of my knowledge and belief and that nothing has been
concealed or withheld by me. I understand that if any of my particulars/entries are found false or incorrect before or after the examination, my candidature
shall be rejected and further action can be taken against me by DGCA as deemed fit. Further, I understand that unutilized fees paid(if any), for previous
session(s), will not be adjusted, carried forward for future examination(s)
It is an offence to make, with intent to deceive, any false representation for the purpose of procurring the grant, issue,renewal or variation of any certificate,
licence, approval, permission or other document. Persons doing so render themselves liable, on summary conviction, to a fine of one lakh rupees and / or
imprisonment for a term not exceeding three months . Further , it renders the person permanently ineligible to have an Aircraft Maintainance Engineer's
Licence.
I declare that I have read and understood the INSTRUCTIONS.

PLACE SIGNATURE

DATE NAME

CERTIFICATE
This is to certify that the particulars furnished by Mr/Ms . Bhagwan Singh Negi given above have been verified by me and found correct.

Date: Seal of Signature:

Organisation
Place: Name
and Designation:
This certificate to be attested by QM/Chief Instructor of approved AME Training Institute/Chief Engineering Officer in case of serving Defence personnel
and Gazetted officer / Self Attested in case of PRIVATE/ Unemployed candidate.