BASIC SAFETY TRAINING

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*
  Indos No.
  Passport No.
  CDC No.
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)
PARTICULARS OF 10th EXAMINATION
Mark Obtained Maximum Mark
  English*
  Total*
  Class
  Year
  Registration Number
  Name Of The Board
All correspondence / updates will be sent to this EMail ID / Mobile No.
PLEASE INDICATE WHICH PROGRAMME YOU WOULD PREFER TO JOIN
  Course *
  Are you aware of our fee structure?*

  Applying through*



   
Bank Details
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
   
RLINS