Please Fill All Fields. This Helps Us to Counsel Better & React Faster.

* Required Fields
* First Name
Last Name
* Sex	Male    Female
* Date of Birth	Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Street Address
Suburb
* City
*State/Province
Zip/Postal Code
Country
Resi Phone	-
Work Phone	-
FAX
MOBILE
* E-mail
Web Site if any
*Universities Interested In :	Select New Zealand Maritime School, Auckland Nelson School of Marine Studies, Nelson
Course Interested In :	Select Deck Cadet courses for 10+2 students, NZ Master F.G COC , NZ Mates/Masters F.G COC , NZ 2nd Mate F.G COC , NZ Marine Engineer Class 1 COC, NZ Marine Engineer Class 2 COC , NZ Marine Engineer Class 1/2 COC , NZ Marine Engineer Class 3 COC , NZ Diploma in Nautical Science, NZ Diploma in Marine Engineering, NZ
Education :	Certificate Name of Institute From To %age
Pre Sea Training :	Certificate Name of Institute From To %age
Technical College :	Certificate Name of Institute From To %age
STCW Courses :
Certificate of Competency :	Certificate COC No. Place of Issue Date of Completion
Shore Based Experience :
Sea Experience :	Vessel'Name Type of Vessel IMO No. Vessel Details Rank From To
How did you learn about us :
Have You Planned Your Career Planning?	Yes No
Do You Want Help?	Yes No
How do you plan to fund your studies?	Parents Own savings Student loans (requires collateral) Scholarships (few in number, available to outstanding students) Others (Please Specify)
Are your parents aware of your plans?	Yes    No
What is your motivation in doing this course?	To improve career prospects for India To improve career prospects for overseas Prospects for immigration Others (Please Specify)
Covering Letter