GME PROGRAMME
Online Application Registration Form
Fields marked with * are mandatory
Personal Details
  Application No.
  Name of the Candidate*
  Father's Name*
  Date of Birth*
  Marital Status*
Place of Birth
  City / Town / Village*
  District*
  State*
  Pincode*
  Nationality*
  Religion*
  Community*

  Annual Income of Parents*
Address for Communication
  Flat/Door/Name of Building*
  Road/St./Lane/P.O.*
  Area / Locality*
  Town/City/District*
  Pin-Code*
  State/Union Territory*
  Phone - Home
  Mobile*
(Please give a valid Number)
  Email*
(Please give a valid Email ID)
All correspondence / updates will be sent to this EMail ID / Mobile No.
 
  Course*
  Are you aware of our fee structure?*

  How do you propose to arrange funds to pay the required fees?*

  Applying through*

  Counselor's Name*
Bank Details for Payment of Reservation Amount
Name of beneficiary- R.L. Institute of Nautical Sciences
Beneficiary's Bank Name- City Union Bank
Address- 82A, Tamil Sangam Road, Madurai - 625 001
Account No. - 027109000119084
Account Type. - Current A/c
Branch Madurai Main
IFSC Code CIUB0000027
  Mode of Payment

  UTR No
  Date of remittance (dd/mm/yyyy)
  Name of the Remitting Bank
  Branch Name & Place