INDIAN COAST GUARD

ONLINE APPLICATION FORM

Application No. : 116/916087   Roll No. : EYP/CH/B/116/11399  
(1) Name of the post applied for : Yantrik Technical (Electrical)
(2) Centre allotted by Coast Guard for written test  :-   COAST GUARD
DIST HQS NO-5 GM PETTAI ROAD, ROYAPURAM, CHENNAI-
600013
Date and Time of  Reporting at Centre : 10 Oct 2015 Time 12:00:00
Choice of Centre(s) you have opted for appearing Test  :-
Priority Centre Name Full Address of the Centre Affix recent
passport size
THE COMMANDER, COAST GUARD
colour Photo
  DIST. HEADQUARTERS NO.6(AP),PO
VISHAKAPATNAM
1 BOX NO.1128 , MALKAPURAM PO,
- VZ
VISHAKAPATNAM, ANDHRA PRADESH
-530011
(3) Name of the candidate (as in Matriculation)
  REDDI SATEESH  Gender : Male
(4) Current postal address:
CHINANANDAPALLI(VILLAGE,POST) DEVARAPALLI(MANDALAM), CITY:
  VISAKAPATANAM, STATE: ANDHRA PRADESH, DISTRICT :
VISAKHAPATNAM, PIN : 531030
(5) Permanent address:
CHINANANDAPALLI(VILLAGE,POST) DEVARAPALLI(MANDALAM), CITY:
  VISAKAPATANAM, STATE: ANDHRA PRADESH, DISTRICT :
VISAKHAPATNAM, PIN : 531030
(6) E-mail ID :    sateeshreddi5@gmail.com
(7) Mobile No :    +918885931159
(8) Father's name : R.APPARAO
(9) Category : OBC  (10) Date of Birth : 12 Jul 1994   (11) Nationality : Indian
(12) Qualification :
Compl. Compl. Year of
Qualification Board/Institution AggrPercent
  Subject Mark Passing
Diploma   74.11 --NA-- 0 0
(13) Knowledge of Swimming : YES
(14) Proficiency in sports, National Level (attach photocopies of certificate) : NO
(15) NCC 'C' certificate- Grade obtained (attach photocopy of certificate, if yes) : --NA--
(16) Marital Status : Unmarried
(17) Declaration :
I, hearby solemnly declare that all the statements made in the above application
are true and correct to the best of my knowledge and belief. I fully understand
 
that in the event of any information being found false or incorrect, appropriate
action can be taken against me.
  NOTE:
Candidates should bring domicile certificate as per the permanent address
  mentioned in the application form. Candidates without domicile certificate
 will not be allowed to sit in the examination. {FOR NAVIK(GD) ONLY}
Place : VISAKAPATNAM Signature :
Name of the Applicant :
Date : 09/08/2015
REDDI SATEESH
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