Springdale Maritime Academy, Bhubaneswar

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Personal Details 1
Personal Details 2
Personal Details 3
Education 1
Education 2
Other
Declaration
Documents

Personal Details 1

Course Applied *

Year of course *

Month (Intake) of course *You application for must reach SAMET 2 months before the respective course intake and start of the beginning session.

Your Name *

Email *

Gender *

Date of Birth *

Nationality *

State *

Marital Status *

Travel document/ Passport Number

Country where Passport was issued

Place where Passport was issued

Expiry Date of Travel Document

Personal Details 2

Address *if different from the above

City *

PIN Code *

Country *

Mobile Number *(with STD code,if any)

Phone No(with STD code,if any)

Father's Name *

Father's Occupation

Father's Date of Birth

Father's Nationality

Mother's Name *

Mother's Occupation

Mother's Date of Birth

Mother's Nationality

Personal Details 3

Guardian's Name

Guardian's Relationship

Guardian's Occupation

Guardian's Date of Birth

Guardian's Nationality

Applicant's average monthly income for the past 6 monthsin INR

Applicant's Current Savingsin INR

Father's average monthly income for the past 6 monthsin INR

Father's Current Savingsin INR

Mother's average monthly income for the past 6 monthsin INR

Mother's Current Savingsin INR

Guardian's average monthly income for the past 6 monthsin INR

Guardian's Current Savingsin INR

Education 1

Name of Qualification1 Obtained *

Name of School/ Institution for Qualification1 *

Year of Qualification1 Obtained *

Country/State of the Institution for Qualification1 *

Period of Study of Qualification1 from *

Period of Study of Qualification1 to *

Name of Qualification2 Obtained *

Name of School/ Institution for Qualification2 *

Year of Qualification2 Obtained *

Country/State of the Institution for Qualification2 *

Period of Study of Qualification2 from *

Period of Study of Qualification2 to *

Name of Qualification3 Obtained

Name of School/ Institution for Qualification3

Year of Qualification3 Obtained

Country/State of the Institution for Qualification3

Period of Study of Qualification3 from

Period of Study of Qualification3 to

Education 2

Name of Qualification4 Obtained

Name of School/ Institution for Qualification4

Year of Qualification4 Obtained

Country/State of the Institution for Qualification4

Period of Study of Qualification4 from

Period of Study of Qualification4 to

Name of Qualification5 Obtained

Name of School/ Institution for Qualification5

Year of Qualification5 Obtained

Country/State of the Institution for Qualification5

Period of Study of Qualification5 from

Period of Study of Qualification5 to

Other

Have you ever been refused entry into or deported from any country, including India? *if yes,cite details

Have you ever been convicted in a court of law in any country, including India? *if yes,cite details

Have you ever been prohibited from entering India? *if yes,cite details

Have you ever entered India using a different Passport or Name? *if yes,cite details

Declaration

I confirm that all the statements given in this application are true and accurate to the best of my knowledge. I have not deliberately omitted any relevant fact. Should I be admitted to SAMET on the basis of the above information which should later turn out to be false or inaccurate, I understand that I will render myself liable to appropriate action, including civil action, disciplinary action, dismissal from course, forfeiture of fees, fine and other disciplinary measures.
I understand that SAMET has the sole discretion to reject any applications.
I agree to abide by the decision of SAMET concerning this application and accept that SAMET reserves the right to withdraw any projected course intakes if there are insufficient applicants.

* Yes

Documents

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