Online admission form for ISPS courses


NAME OF THE STUDENT:   

DATE OF BIRTH:                    (DD/MM/YY)

COURSE APPLYING FOR:   
                        
INDOS NUMBER:                  
 
INDIAN CDC NUMBER:       
 
PASSPORT NUMBER:           
 
ISSUING COUNTRY:            
 
HOLDING CERTIFICATE OF COMPETENCY GRADE:       NUMBER:  
 

  1. INFORMATION OF NEXT OF KIN (in case of emergency):
     
    NAME:                          
     
    Father's Name:               
     
    Relationship:                   
     
    Permanent address:                                 

          Telephone No. (with code):  

   2.    Local Address:              

   3.    Email id:                        

   4.    Telephone (Kolkata):     

   5.    Name of Company last served:     

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Marine Engineering & Research Institute, © 2001. All Rights Reserved.
P-19, Taratolla Road. Kolkata: 700 088. West Bengal, India.
Phone: (033) 2401 4673/4674/4675/4676/4678/3677, 2401-1943/1944/1945
Fax: (033) 2401 4431/4333.