Admission Application Form

First Name

Middle Name

Last Name

Mobile

Date of Birth

Age

Blood Group

Gender

Email Id

Marital status

Nationality

Mother Tongue

Aadhar Card Number

Pan Card Number

Place of birth

Height (Cms)

Weight (Kgs)

Name

Occupation

Company

Designation

Income

Mobile No

Name

Occupation

company

Designation

Income

Mobile No.

House No / Building No

Village / Post Office / Tehsil

City / District

Pincode

State

Country

Tel. No With STD Code

House No / Building No

Village / Post Office / Tehsil

City / District

Pincode

State

Country

Tel. No With STD Code

Passport No

Date of Issue

Place of Issue

Valid Upto

Qualification

Result Status

Year Of Joining

Year Of Passing

English Percentage

Final Percentage

School / College

Board / University

Class X

Qualification

Result Status

Year Of Joining

Year Of Passing

English Percentage

Physics Percentage

Chemistry Percentage

Math Percentage

PCM Percentage

Final Percentage

School / College

Board / University

Class XII

Qualification

Branch

Result Status

Year Of Joining

Year Of Passing

English Percentage

Final Year Percentage

Aggregate Percentage

School / College

Board / University

Diploma

Semester 1

Semester 2

Semester 3

Semester 4

Semester 5

Semester 6

Qualification

Branch

Result Status

Year Of Joining

Year Of Passing

English Percentage

Final Year Percentage

Aggregate Percentage

School / College

Board / University

Degree

Semester 1

Semester 2

Semester 3

Semester 4

Semester 5

Semester 6

Semester 7

Semester 8

Qualification : Class X

Year Of Joining

Result Status

Year Of Passing

English Percentage

Final Percentage

School / College

Board / University

Qualification : Class XII

Year Of Joining

Result Status

Year Of Passing

English Percentage

Physics Percentage

Chemistry Percentage

Math Percentage

PCM Percentage

Final Percentage

School / College

Board / University

Qualification : Diploma

Select Branch

Year Of Joining

Result Status

Year Of Passing

English Percentage

Final Year Percentage

Aggregate Percentage

School / College

Board / University

Semester 1 Percentage

Semester 2 Percentage

Semester 3 Percentage

Semester 4 Percentage

Semester 5 Percentage

Semester 6 Percentage

Qualification : Degree

Select degree

Year Of Joining

Result Status

Year Of Passing

English Percentage

Final Year Percentage

Aggregate Percentage

School / College

Board / University

Semester 1 Percentage

Semester 2 Percentage

Semester 3 Percentage

Semester 4 Percentage

Semester 5 Percentage

Semester 6 Percentage

Semester 7 Percentage

Semester 8 Percentage

IMU Registration Number

Hall Ticket Number

Rank

I intend to meet the expenses of course through

Where did you hear about School of Maritime Studies, Centurion University of Technology & Management.

Name of Person

Designation

Company Name

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Physical Details

Father's / Guardian Details

Mother's Details

Permanent Address

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Correspondence Address

Passport Details

Academic Qualification

XII Academic Qualification

Diploma

Degree

Academic Qualification

IMU CET Details

Hobbies & Other Achievements

Other Details

Reference

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