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in

ADMISSION FORM
Please tick the program you are applying for:

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B.Sc - Maritime Studies (Lateral Entry) MBA - Port & Shipping B.Sc (Maritime Studies) + MBA (Port & Shipping)

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Personal Details

IMPORTANT GUIDELINES: All the below mentioned field are mandatory. Please mention N/A wherever not applicable

1. 2. 3.

Name (in Block Letters) Date of Birth Correspondence Address

: : : Gender M F

Pin 4. Permanent Address :

Pin 5. 6. 7. 8. Telephone (Res.) Email Nationality Occupation : : : : Mobile :

Centre for Continuing Education (CCE)

University of Petroleum & Energy Studies

9.

Name of the Company

: : :

10. Designation 11. Companys Address

12. Telephone (Off.)

13. Certificate of competency details (if applicable) : 14. Experience :

Educational Qualifications

Stream

%/Grade

Board/University

Year of Passing From To

Class X Class XII Graduation Post Graduation Any Other

Work experience

Name of the Organization

Designation

Years of Experience From To

Your interest in joining UPES?

Centre for Continuing Education (CCE)

University of Petroleum & Energy Studies

Licenses Obtained (if any) Technical/Non-technical

Name

Agency

Validity

Special Achievements

How did you hear about us?

Website

Newspaper

Emailer

Magazine

Any Other.......................................

Declaration
I hereby state that the information given above is true to the best of my knowledge. In case any information is found to be incorrect, my candidature is liable to be cancelled by the University. I shall abide by the rules and regulations of the University of Petroleum and Energy Studies, including dress code, and expected behavioral norms in line with the Universitys special charter for the Oil & Gas Industry. I shall ensure timely payment of all applic able dues.

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Students Signature

Centre for Continuing Education (CCE)

University of Petroleum & Energy Studies

www.cce.upes.ac.in

INFORMATION FORM FOR IDENTITY CARD

IMPORTANT GUIDELINES: All the below mentioned field are mandatory. Please mention N/A wherever not applicable 1. Name of Program :

2. 3. 4.

B.Sc - Maritime Studies (Lateral Entry) MBA - Port & Shipping B.Sc (Maritime Studies) + MBA (Port & Shipping)

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Duration of the Program : Enrollment No. (For Office use only) : Students Name (in English Capital Letters) : Fathers Name Mothers Name Correspondence Address : : :

5. 6. 7.

8.

Permanent Address

9.

Telephone No.

: : :

10. Emergency Contact No. 11. Blood Group

Authorized Signatory Centre for Continuing Education (CCE)

Specimen Signature of the Student University of Petroleum & Energy Studies

INSTRUCTIONS FOR SENDING THE ADMISSION FORM

Please send the filled in Admission Form along with: 1. 2. 3. 4. 5.
6.

Non-refundable Admission form fees of Rs. 1,000/- (through demand draft) in favor of Indico Marine Pvt.Ltd., payable at Mumbai Xth & XIIth class certificate and mark sheets (photocopy should be self attested). Graduation certificate & mark sheets (photocopy should be self attested). Post graduation certificates & mark sheets (photocopy should be self attested). Any other degree/diploma/certificates (as mentioned in the application form). Certificate of competency details (if applicable) (photocopy should be self attested). CDC copy and relevant sea experience proof (photocopy should be self attested). 2 passport size photographs. Work experience certificate(s).

7. 8. 9.

10. Youre CV. 11. Completed ID form. 12. On confirmation fees to be paid to UPES in favor of UPES FEE ACCOUNT payable at DEHRADUN All these documents should reach us at the earliest at the following address: Ms.Pooja (+ 91 9920073451) Mr.Anuj Nautiyal (+ 91 9820576509) INDICO Education Indico Marine Pvt. Ltd. 1203, Mayuresh COSMOS, Plot-37, Sector-11, CBD Belapur, New Mumbai - 400 614 Tel: + 91 22 27580015 / 6 Email: indicoeducation@gmail.com Web: www.indicoeducation.org

www.indicoeducation.org
Centre for Continuing Education (CCE)

www.cce.upes.ac.in
University of Petroleum & Energy Studies