INDIAN COAST GUARD
APPLICATION FORM FOR THE POST OF ENROLLED FOLLOWER FROM
MAHARASHTRA STATE ONLY
LAST DATE OF RECEIPT – 05 AUG 25
Affix recent
FILL ALL COLUMNS IN BLOCK CAPITAL LETTERS passport
size photo
1. Recruitment Centre: Mumbai
2. Name of the Candidate (as in Matriculation Certificate):
3. Father‟s Name (as in Matriculation Certificate):
4. Date of Birth (as in Matriculation Certificate)
/ /
5. Whether you belong to SC/ST/OBC/EWS (attach photo copy of Certificate)
6. 10th/ITI Certificate No. _______, Board _______ Pass year/location/Board Office
address of the board with pin code.
7. Educational Qualifications:
Exam Passed Subject Studied Marks obtained in Aggregate %
each subject
8. Complete Postal Address:-
State:
in Code:
Mobile No.
Email Id.
9. Complete Permanent Address:-
State:
Pin Code:
Mobile No.
Email Id.
10. Declaration:-
(a) I, hereby solemnly declare that all the statements made in the above application
are true and correct to the best of my knowledge and belief. I fully understand that in
the event of any information being found false or incorrect, appropriate action can be
taken against me.
(b) I undertake to produce all my original certificates and statement of marks and
three photocopies of each, duly self- attested at the time of appearing in the selection
test.
Place: ____________
Date: ____________ Signature of the Candidate
(Left thumb impression of the Candidate)