Air Force

APPLICATION FOR 77 AEC (MEN)/49 (WOMEN) COURSES COMMENCING IN JULY 2010

FOR OFFICE USE APPLICATION NO.

FOR AFSB USE BRANCH

AFSB

CODE NO.

1.NAME IN BLOCK CAPITAL AS IN MATRICULATION CERTIFICATE

2. FATHERS NAME AS IN MATRICULATION CERTIFICATE

3. PERMANENT ADDRESS WITH PIN CODE AND TELE NO. IF ANY

4. PRESENT ADDRESS WITH PIN CODE AND TELE. NO. IF ANY

5. choice of EKT center 1.___________________________ 2.________________________________

CHEST NO.

6. DATE OF BIRTH (DD/MM/YY) 7. MARITAL STATUS: SINGLE/MARRIED/WIDOWER/WIDOW/DIVORCEE

8. SEX- MALE/FEMALE

9. E-mail: ______________________________________________________________________________ 10. VISIBLE IDENTIFICATION MARK: _________________________________________________ 11. EDUCATIONAL QUALIFICATION a) b) c) d) e) f) g)

Technical qualification (BE/B.Tech )__________________________________________ Name of College & Place __________________________________________________ Name of university _______________________________________________________ Engineering discipline_____________________________________________________ Likely date of final result (For appearing students) Semester / Year wise marks: Details of present backlog if any _________________________________________________ Semest Maximu Marks % of Semest Maximu Marks % of er/ m Obtaine Marks er m Marks Obtaine Marks Year marks d d

h) Details of present backlog if any _________________________________________________ 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 I have never been debarred from appearing in any examination nor, I have ever been withdrawn from defence training establishments on disciplinary grounds, nor have I ever been arrested, procecuted or convicted by criminal court or involved in any other case registered by the police. 3. I undertake not to make any claim for compensation if at any stage of my selection , my ineligibility for candidature is detected & my candidature is cancelled as a result thereof.

4. This is the only application submitted by me fo 77 AEC (men)/49 (women) course. 5. Any willful misrepresentation of facts & concealment of facts of information will result in the cancellation of the candidature and may debar permanently or for a specified period from applying for the future courses.

Place___________________ Date____________________ Signature of applicant