Application Form No.

USE CAPITAL LETTERS ONLY

Instructions: FILL FORM WITH BLUE INK ONLY

DO NOT OVER WRITE

APPLICANT INFORMATION

Applicant Name :

Date of Birth: Religion: Nationality :

Contact No: WhatsApp No.:

Father’s Name: Contact No:

Mother’s Name: Contact No:

Father’s Occupation: Mother’s

Occupation: Present Address:

Permanent Address:

Email Address: Passport No.:

Languages Known:

ACADEMIC INFORMATION
Examination Passed Year of Passing Board / University Percentage(%)

10th

10+2

Diploma / Degree / ITI

Others

MEDICAL INFORMATION
Medically Fit Yes No Height (in Cms) Weight (in KGs)

Any Visual Yes Eye Vision

Aids
No

Color Blindness Yes No Identification Mark

Can you swim? Yes No Communication Skill

 DECLARATION

I hereby declare that the information provided by me in this application is true, complete, and correct to
the best of my knowledge and belief. I understand that if any information is found to be false or
misleading, my admission may be cancelled without prior notice. I confirm that I have thoroughly read
and understood the prospectus and related documents issued by Seashore Maritime Academy and agree
to adhere to all terms and conditions stipulated therein. I understand that my placement will be based
entirely on my performance during training, and I accept full responsibility for any costs associated
with on-board training. I undertake to collect all relevant documentation, including the Basic STCW
(2010) course certification, INDOS number, and Indian CDC, upon successful completion of the
required training. I acknowledge that these documents are issued in accordance with Gazette
Notification G.S.R. 883(E) dated 14.07.2017, and I agree to comply with any future updates or
directives from the Directorate General of Shipping, including those outlined under F. No. CR/CDC
(Special)/08/13-VOL-1. Upon receipt of the aforementioned documents, I hereby release and discharge
Seashore Maritime Academy, along with its officers, directors, and representatives, from any and all
claims, demands, or liabilities, whether direct or indirect. I affirm that I shall not initiate or pursue any
form of legal proceedings against the academy in any forum or jurisdiction. I further affirm, on behalf
of myself and my family, that we voluntarily waive any right to take legal action against Seashore
Maritime Academy. I acknowledge that any fees paid by me to the academy are strictly non-refundable
under all circumstances. Should I, at any point, choose to initiate legal action—including but not
limited to filing a police complaint, issuing a court notice, or submitting any grievance through
governmental or private means—against Seashore Maritime Academy, I understand and accept that the
academy reserves full legal rights to take appropriate action against me. I confirm that both I and my
family have been duly informed of all relevant terms and conditions, and I accept these with full
awareness and free will.

(Date) (Signature of Applicant) (Signature of

Parents) DOCUMENTS TO BE SUBMITTED ALONG WITH THIS

APPLICATION

• Attested Copy of School Leaving Certificate / Birth Certificate

• Attested Copy of 10th / 10+2 Final Examination Passing Certificate
• Attested Copy of Passport ( if available )
• Medical Fitness Certificate & Eye Sight Test Certificate
• Original of all above documents – For Verification
• Identity & Address Proof
• Recent Passport Sized Photograph - 8

FOR OFFICE USE ONLY

Status ✔ Selected Rejected Waitlisted

Selected For

( Date ) Document Verified By :

Signature:
 Date:………………………
To Whom It May Concern,
This is to formally certify that:

Candidate Name: S/o Mr.:

Selected For: Address:

Village/Post: Tehsil & District:

Pincode: Mobile Number:

We extend our congratulations on your selection. Kindly note the following terms and conditions
associated with your admission and training:
1. Admission & Refund Policy
Once a candidate is admitted, if the individual withdraws or drops out during the course of training,
the institute will not provide any refund under any circumstances. All terms and conditions are clearly
communicated to candidates prior to admission.
2. Training & Placement
 The academy is responsible for the complete training process, which includes classroom
instruction, hands-on training, and arranging on-board placement.
 Final placement is merit-based, contingent entirely upon your performance during training.
 All expenses related to on-board training—including visa, tickets, medicals, insurance, and
service charges—must be borne by the candidate. These charges vary depending on
destination country or ship category and are communicated in advance.
3. On-board Training Disclaimer
 If a candidate chooses to leave their ship assignment due to personal issues, the academy and
its affiliated companies shall not be held responsible for any resulting disruption or
disqualification.
 Once on-board training has commenced, the candidate and their family waive all rights to
pursue legal action of any kind against Seashore Maritime Academy.
4. Compensation Package
After successful placement and commencement of on-board duties, candidates will receive the
following salary package:

*Accommodation and dearness allowance

Placement Location will be provided free of charge.
Salary Package
Abroad (International) USD $250 – $300/month
India (Domestic) ₹10,000 –
₹15,000/month
Declaration:
I, the undersigned, acknowledge and accept the above-mentioned terms and conditions. I confirm that
I have read and understood the same, and I agree to proceed with full knowledge and consent.

Candidate Signature Authorized Signatory