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					                                    FORMAT FOR APPLICATION
APPLICATION FOR SELECTION FOR GRANT OF COMMISSION IN THE CORPS OF SIGNALS, ENGRS & EME TO
FINAL/PRE-FINAL YEAR MALE STUDENTS OF ENGINEERING COURSES UNDER UNIVERSITY ENTRY SCHEME
                                      (JULY 2007-2008)

1. Name of Engineering College/Institution and
Address:…………………………………………………………………………………………                                                                                                                  Affix Latest
………………………………………………………………………………………………….                                                                                                                     Passport size
2. Branch of Engineering in which studying................................................................………...                                            Photograph
3. Full name in Capitals………………………………………………………………………..                                                                                                     Duly attested by
 (Strictly as per Matriculation/Equivalent Certificate and there should be no deviation)                                                                   Government
4.Father’s Name (in block letters)..................................................................…………………………                                            Gazetted officer
5. Address in full (to which communication correspondence may be sent)
………………………………………………………………………………………………………
………………………………………………………………………………………………………
Distt.....................State.......................................Pin Code........................................………….
6.Permanent Address...........................................................................................................................
...........................................................................................................................................………….
Dist..............................State.......................................Pin Code........................................………….
7.Date of birth (Christian Era)......................................................................................……………
Note: Please attach copies of Matriculation/Hr.Sec. /Sr.Sec. Certificate showing date of birth duly attested by
Govt.Gazatted officer……………………………………………………………………
8. Are you a citizen of India by birth or domicile?………………………………………
9. Religion…………………………………………………………………………………
10.Single or Married………………………………………………………………………
11. Details regarding Educational Qualifications :
       a. Year of passing 10th Class…………………………………………………………
       b. Year of passing 12th Class…………………………………………………………
       c. Date of joining Engineering College………………………………………………
       d. Progress in Engineering College…………………………………………………...
Name of Examination                                                   Month & Year of Passing                                             Total marks obtained

1st Semester                                              ………………………………….                                               …………. Out of………………
2nd Semester           1st year                           ………………………………….                                               …………. Out of………………


3rd Semester                                             ………………………………….                                                …………. Out of………………
4th Semester             nd
                       2 year                             ………………………………….                                               …………. Out of………………


5th Semester                                            ………………………………….                                                  …………. Out of………………
6th Semester           3rd year                         ………………………………….                                                  …………. Out of………………

(e). Presently studying in (Given status for Academic year 2005-2006: - Final year or Pre – Final year)………………..
(f.) From which date you have been a student of Final*/ Pre Final*(* delete whichever is not applicable) Year class of
Engineering College……………………
(g) Probable month & year of conduct of examination:
     (i)     Pre-Final Year…………………………….
     (ii)    Final Year/ Final Semester…………………
12. Have you served in the NCC? If so, give details of ranks and certificate obtained.
13. Are you bonded to serve the Central or State Govt. after passing your Engineering degree examination? ………….
14. Indicate below in order of the performance the arms or service. Engineering, EME & Signals in which you would like
to serve on grant of Permanent Commission under university Entry Scheme.
1st Preference……………………………………………………………..
2nd Preference……………………………………………………………
3rd Preference…………………………………………………………….
15. Have you appeared in SSB interview previously…………………………………….yes/no
If yes, give following information:
     a. Batch No…………………….
     b. Whether Recommended or Not………………..
     c. Place And Date of Interview……………………..

16.Any other relevant information.
                                          DECLARATION BY THE CANDIDATE

(1). I hereby declare that all the statements made in the application are true to the best of my knowledge and belief.
(2). I have never been debarred from appearing at any examination nor have I ever been withdrawn from
NDA/IMA/OTA on disciplinary grounds, nor have I ever been arrested prosecuted or convicted by criminal court or
involved in any other case registered by the police.
(3). I have not qualified for UES-15 course as a pre-final year candidate.
(4). This is only application submitted by me for UEs-16 course and if any duplicate application is detected, my
candidature be cancelled and I may be debarred permanently from applying for commission in the Armed Forces.
(5)In the event of any information being fount false or incorrect or incomplete at any stage, my candidature under UES
will be cancelled.
(6). I undertake not to make any claim or compensation if at any stage of my selection, my intelligibility for candidature is
detected and my candidature is cancelled as a result thereof.
(7). I undertake not to have any objection in the event of my final selection on the allotment of any Arm/Service in the
interest of service made to me prior to passing out from IMA.
(8). In case I do not figure in the order of merit for UES-16 course I am willing to be inducted into parallel TGC/next SSC
(T) course and be governed be the terms and condition of that course. (score out this sub-para if not willing).
Place .........................
Date..............................                                                Signature of Candidate

CERTIFICATE BY THE VICE CHANCELLOR OR REGISTRAR / EAN OF CONCERNED FACULTY IN CASE OF
UNIVERSITY STUDENTS/PRICIPAL/HEADS OF THE TECHNICAL INSITUTIONS

Certified that Shri ……………. Is studying in this University /College/Institute and that details furnished by him in
column 7 and 11 of the Application Form have been checked with reference to relevant records and found correct.
Certified that his character so far as known to me is good. He is suitable for selection as an officer in Technical
Army/Service of the Army.

Place…………..                              OFFICE                   Signature………………….
Date…………..                               SEAL                     Designation ……………….



Note: The certificate is to be signed by Head of the Institution. Certificate signed by Heads of Departments will not be
acceptable.

				
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