<%@ page language="C#" autoeventwireup="true" inherits="registration, App_Web_4nj5x542" %> <%@ Register assembly="AjaxControlToolkit" namespace="AjaxControlToolkit" tagprefix="asp" %> EMA -SAFETY INSTITUTE BHUBANESWAR | SAFTY COURSE BHUBANESWAR | INDUSTRIAL SAFETY COURSES PROVIDER INSTITUTE | BHUBANESWAR | ODISHA | INDIA
EMA - Safty Institiute bhubaneswar

EEURO MARITIME ACADEMY

Managed By Institute of Technical and Educational Organization [ITEO] Trust.
Regd. under Govt.of India

+91 - 909 036 6575

SAFETY INSTITUTE BHUBANESWAR | SAFTY COURSE BHUBANESWAR | INDUSTRIAL SAFETY COURSES PROVIDER INSTITUTE | BHUBANESWAR | ODISHA | INDIA

APPLY ONLINE FOR ADMISSION

For Official Use:

ID Number for Student:

Student Details

Complete Name:
Course applied For:
Safty Officer Marine Mechanical Fitter
Gender:
Male Female
Date of Birth:
Place of Birth:
Email ID:
Student Country:
India China
Nationality:
Phone Number:
Father's Name:
Mother's Name:
Complete Address:
Next to KIN Relation [ NAME AND ADDRESS DETAIL]:
STANDARD PASSED
10th +2 Diploma B-Tech
PASS IN SUBJECTS
Can You Swim ?
Yes No
RELIGION
LANGUAGE KNOWN
PERSONAL IDENTIFICATION MARK
HEIGHT
EYE SIGHT NORMAL [Y/N]
Yes No
COLOUR BLINDNESS [Y/N]
Yes No
HAIR COLOUR :
VISIBLE DISTIGUSHING MARK :
COLOUR OF EYES :
COMPLEXION :
Declaration: I will be flow the all rules and condition for this training course by EMA. ( course fee once paid will not be refundable or it is under refund policy)
Applicant Signature:
Date: