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Indian Coast Guard - Application for Enrolled Personnel
Application Status
REGISTRATION
2107NDB0163741 APPLIED BRANCH Navik(DB) PAYMENT STATUS Paid
NUMBER
Personal Information
NAME Ghagare Datta FATHER'S NAME Sambhaji MOTHER'S NAME Sunita
Sambhaji
EMAIL ID ghagaredatta4@gmail.c MOBILE 918600791019 ALTERNATE 9370652107
om MOBILE
NATIONALITY Indian MARITAL Unmarried GENDER Male
STATUS
AADHAR NUMBER XXXXXXXX4869 PHOTO ID CARD Aadhaar Card PHOTO ID CARD XXXXXXXX4869
NO.
IDENTIFICATION Mole on Below the IDENTIFICATION Mole on the left side of CATEGORY Other Backward
MARK 1 Right Ear MARK 2 the neck Class (OBC)
(Non-creamy)
DATE OF ISSUE 24-Jul-2019 CATEGORY 31-Mar-2022 DATE OF BIRTH 02-Dec-2003
OF CATEGORY CERTIFICATE
CERTIFICATE VALID UPTO
DATE OF BIRTH 10th Class AGE RELAXATION No FEE WAVIER No
CERTIFICATE Certificate CLAIMED
TYPE
EMPLOYMENT Unemployed
TYPE
Class 10th details
EDUCATION Maharashtra GRADING SYSTEM Percentage DO YOU HAVE No
BOARD State Board of INDICATED IN ADDITIONAL
MARKSHEET MARKSHEET
Secondary and
Higher
Secondary
Education
AGGREGATE 67.666 10TH GRADE 060085 DATE OF ISSUE 08-Jun-2019
PERCENTAGE CERTIFICATE OF GRADE 10TH
BASED ON NUMBER MARK SHEET
CONVERSION
FORMULA
Marks Total
Subject
Obtained Marks
English 59 100
Hindi 68 100
Marathi 73 100
Mathematics 89 100
Indian Coast Guard Designed & Developed
by C-DAC, Pune
Science And
66 100
Technology
Social Sciences 51 100
Additional Details
1) Whether having NCC 'A/B/C' Certificate : No
2) Whether studied in Sainik school: No
3) Whether serving in Armed Forces No
4) Have you represented at any level in sports? No
5) Do you know Swimming? No
6) Are you son of a Serving / Retired / Discharged Deceased Coast Guard No
Personnel (Officer / SO / EP / Civilian Staff)
7) Are you Son of a Coast Guard Personnel whose death is attributable to service? No
8) Are you Son of a Coast Guard Personnel whose death is not attributable to No
service?
9) Are you Child Of War Widow of (Army/Navy/Air Force)? No
10) Are your parents (father / mother) serving / retired from Defence Forces? No
11)Whether you are employed in Central / State Govt. / Public sector No
12) Have you been Discharged from the Indian Army / Indian Navy / Indian Air No
Force or any government organization ?
13) Has any warrant or summons for your appearance as witness been issued and No
pending before a court of law for the time being in force ?
14) Are any proceedings in respect of an offence alleged to have been committed No
by you pending before a criminal court in India ?
15)Has any warrant or summons for your offence been issued and pending before No
a court of law for the time being in force ?
16) Has a warrant for your arrest been issued by a court under any law for the time No
being in force ?
17) Have you, at any time preceding the date of this application, been convicted No
by a court of India for any offence and sentenced in respect thereof to
imprisonment ?
18) Have you applied in higher court for acquittal against the conviction of lower No
court?
19) Have you ever been debarred by ICG / Army / Navy / Air Force / UPSC / No
Central or State govt. during any recruitment process ?
Communication Details
Permanent Address
HOUSE/STR Nirankar Colony LANDMARK Sanjaynagar, Sangli POST OFFICE Sangli
EET
COUNTRY India STATE/ UT MAHARASHTRA DISTRICT SANGLI
SUB Miraj PIN CODE 416416 PHONE NO WITH N.A
DISTRICT AREA CODE
Present/Current Address
HOUSE/STR Nirankar Colony LANDMARK Sanjaynagar, Sangli POST OFFICE Sangli
EET
COUNTRY India STATE/ UT MAHARASHTRA DISTRICT SANGLI
SUB Miraj PIN CODE 416416 PHONE NO WITH N.A
Indian Coast Guard
DISTRICT Designed & Developed
byAREA
C-DAC,
CODEPune
Domicile Details
DOMICILE STATE Maharashtra
Photo And Signature
PHOTO LEFT HAND THUMB IMPRESSION SIGNATURE PARENT SIGNATURE
Stage - I - Exam City Preferences
1. KOLHAPUR
2. SOLAPUR
3. PUNE
4. MUMBAI
5. THANE
Stage - II - Exam City Preferences
1. MUMBAI 2. MANGALORE 3. KOCHI 4. CHENNAI 5. VISAKHAPATANAM
List Of Uploaded Documents
Stage-I
1. Photo Identity Proof
2. Date of Birth Certificate
3. Other Backward Class (OBC) (Non-creamy) Category Certificate
4. 10th Class Marksheet
5. 10th Class Certificate
Declaration
I hereby declare that all the above information provided by me is correct.
Iowe allegiance to the sovereignty, unity and integrity of India. I have not lost, surrendered or been deprived of the
citizenship of India.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not
suppressing any material information in this regard. I further affirm that the certificates (DOB, Matriculation, 10th marks
sheet, Cast Certificate, ID proof) of documentary proof uploaded in support of my application for recruitment of Navik (GD)/
Navik (DB)/ Yantrik (Mechanical)/ Yantrik (Electrical)/ Yantrik (Electronics / Telecommunication (Radio/ Power)) are
authentic and solely pertain to me and I am fully responsible for the accuracy of the same. I am liable to be penalized or
prosecuted and my candidature will be cancelled if found otherwise. I am also aware that my candidature will be
cancelled, if the documents are not found genuine by the issuing authority during subsequent verification by Indian Coast
Guard even if I clear written, PFT and Medical and inducted into service.
I have read the complete advertisement for the said post of Navik (GD)/ Navik(DB)/ Yantrik(Mechanical)/
Yantrik(Electrical)/ Yantrik(Electronics / Telecommunication (Radio/ Power)) of Coast Guard website and I am eligible to
apply. I have also read the FAQ section on Coast Guard Website before filling the online application.
I understand that Indian Coast Guard reserves the right to conduct re-assessment
of candidates at Stage II and also at
any stage of the recruitment process prior issue of
appointment letter to avoid impersonation. I understand that my
candidature can be
cancelled on account of impersonation and the decision of Indian Coast Guard will be final
and binding
on me in this regard.
I have also understood and read the remarks on Coast Guard Website regarding common observation for cancelling the
candidature during document verification. I certify that all my documents meet the criteria as mentioned on CG Website.
I understand that Coast Guard will be communicating the result of written test, Physical fitness test and medical on the
CG Website and/or E-mail and my login. I will not claim for re-examination if I fail to see the requisite communication on
CG Website and/or E-mail and my login.
I understand that Biometric impression is mandatory for appearing in the online written examination, PFT and Medical
Examinations. It is my responsibility to check beforehand that the biometric machines are able to capture the fingerprint
image.Guard
Indian Coast In case, if the biometric machine is not able to capture the fingerprint
Designed imageC-DAC,
& Developed
by due to Pune
Mehndi, wax, etc then, I will not
be allowed to appear in the examination. I will make no further claim in this regard as biometric fingerprinting is one of the
most important access control security system implemented in Indian Coast Guard and cannot be waived off under any
circumstances to rule out impersonation. I understand that if I am not allowed by Coast Guard for appearing in the Online
Written Examination, PFT and Medicals Examinations for non-capture of Biometric due to mehndi, wax, etc. then the
application fees will not be refunded under any circumstances.
NO CLAIM / RISK UNDERTAKING I am a candidate for recruitment in Indian Coast Guard. I give my full and free consent
at my own risk and that I shall not be entitled to claim any compensation or other relief from the government in respect of
any injury or disability which I may sustain in the course of or as the result of any of the tests (both physical fitness test and
medical test) administrated to me or attended by me during the recruitment procedure, whether due to my own
negligence or any other person or otherwise.
I understand that my candidature will be cancelled and I will be debarred from future Coast Guard Recruitment
examinations in case I am found to be involved in malpractice during the current recruitment process of Written test, PFT
and Medical.
I understand that I can apply for only one post in one recruitment cycle i.e. Navik (GD) or Navik (DB) or Yantrik (Electrical)
or Yantrik (Mechanical) or Yantrik (Electronics / Telecommunication (Radio/ Power). I have not submitted multiple
applications in one recruitment cycle. In case if multiple applications are detected by ICG then all my applications will be
rejected and the application fees for all the submitted application forms will not be refunded by ICG.
I am submitting all the above which may include other personally identifiable information, voluntarily. I am fully aware
that Centre for Development of Advanced Computing, C-DAC departments, Indian Coast Guard, Government of India, their
associated agencies and their employees will use this information for Academic, Administrative, Research, Internal Quality
Audits and Legal purposes and I am authorizing them for the same.
Candidate Verified at Candidate Verified at Stage
Candidate Upload Signature Signatue for Stage II by (ICG Signatue for Stage III by (ICG
Stage II Officer) III Officer)
Stamp Stamp
Parent/Guardian Parent/Guardian
Parent/Guardian Signature Signatue for ICG officer Signatue for Stage ICG Officer
Stage II III
Name:
Name:
Rank:
Rank:
Note:- Candidate will have to bring the same application form which is verified at Stage II by ICG while reporting at INS
Chilka Stage III or else the candidature will be cancelled.
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Indian Coast Guard Designed & Developed
by C-DAC, Pune
