East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
Application Form 2016-17
Application Number: ECMA/2016-17/
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8.
Batch Applying for: January | July
Fill up the details in English in CAPITAL LETTERS
Use black ball point pen for filling the details
Put Tick mark wherever applicable and strike out wherever required
Please mention N.A. if not applicable
All the Applications must be accompanied by attested copies of supporting
documents
Read carefully all the terms and conditions given in the Annexure-1 and
sign it as a token of acceptance
Student has to read and sign Annexure-2 Declaration
Annexure – 3 Indemnity Bond by the Student & Parent / Guardian in NonJudicial Stamp Paper
Course Applied for
Affix
Passport Size
Photograph
Here
Diploma | Advance Diploma | PG Diploma in Shipping & Logistics
B.Com | BBA | MBA in Shipping & Logistics
Personal Details:
1. FULL NAME
2. SURNAME
3. Father’s Name
4. Occupation of
Father
5. Mother’s Name
6. Email ID
7. Contact Number
of the applicant
8. Emergency
Contact
9. Next of Kin –
Name, Contact
No. Email ID and
Relationship
10. Date of Birth
____________________________
Parent / Guardian’s Signature
11. Gender
Male / Female
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
12. Address
Permanent Address
Present Address
Pin Code:
State:
13. Aadhar Number:
14. Passport Number / Expiry Date:
15. Nationality:
16. Education Qualification:
Name of the
Name of the School /
Examination
Institution
Pin Code:
Board
Year of
Passing
State:
%
Scored
Subjects
Taken
Medium of
Instruction
10th
10th+2
Degree
17. Special Courses taken / additional Qualification (if any)
18. Employment Details
Name of the Company
Designation
19. Personal Details
Height (CM)
Weight (Kgs)
____________________________
Parent / Guardian’s Signature
Blood Group
From
Allergy (if any)
To
Medical History
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
20. About Yourself
Hobbies
Interests
NCC/NSS
Sports
Cultural activities
A brief about
yours Self
21. Declaration
I confirm to the best of my knowledge that the information given in this Application form
is accurate and I have thoroughly read and fully understood the terms and conditions as
per Annexure-1 and declaration as per Annexure-2.
___________________
Applicant’s Signature
_________________________
Parent / Guardian Signature
22. Enrolment Checklist:
5 Recent Pssport Size Photographs of Applicant in formals
2 Attested copies of Voter ID/Driving License/Aadhar Card/Passport/Ration Card (Any
One)
2 Attested Copies of Transfer / Migration Certificate
2 Attested Copies of 10th, 10+2, Degree Certificate
2 Attested Copies of Conduct Certificate
Annexure – 1 duly signed by the Student & Parent / Guardian
Annexure – 2 duly signed by the Student & Parent / Guardian
Annexure – 3 Indemnity Bond by the Student & Parent / Guardian in Non-Judicial Stamp
Paper
Original Certificates to be presented for verification
For Office Use only
Application Received on:
Verified by (Name):
Admission Approved by:
Verified by (Sign):
____________________________
Parent / Guardian’s Signature
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
Annexure – 1
Terms and Conditions
1.
Enrolment for the course, together with payment of the required
deposits creates a binding agreement to follow the course and pay the
full fees. Even if a student subsequently decides not to complete the
course, no refunds can be made as a seat has been committed to the
student for the duration of the programme and the Academy will not
entertain any request for refunds.
2.
Jurisdiction purpose, the Visakhapatnam court shall have exclusive
jurisdiction in the matter and the laws prevailing in India shall apply.
3.
East Coast Maritime Academy offers tuition on a 'per course' basis and
not based on number of hours of instruction which may vary, East
Coast Maritime Academy further requires all students to attend
lectures, classes, tests and to submit written work as assigned by
lectures and tutors regularly, No classes will be scheduled on public
holidays.
4.
Students will be charged a late fee of Rs. 500 per week per installment
if he/ she fails to pay the tuition fee as per installment structure
agreed.
5.
The students will be liable for all legal expenses incurred in recovering
late or non-payment of tuition fee on an indemnity basis. In the event
of such legal action taken by the training center against you, Academy
reserves the right to claim the full amount due from the student.
6.
Academy reserves the right to dismiss the student from the course at
any time if the student fails to fulfill the above requirements or if a
student's continued presence would, in the opinion of East Coast
Maritime Academy be detrimental to the well - being of the students
and the staff in general. The refund of fees of an expelled student is
wholly at the discretion of the Academy.
____________________________
Parent / Guardian’s Signature
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
7.
The Student shall indemnify the Academy for any loss or damages
occurring as a result of his / her negligence or willful misconduct
during practical visits or during the process of training.
8.
If a student changes his / her course of study during the term, no
refund will be given for the revised courses if the number of subjects
involved are less than that for which original enrolment was accepted.
Additional conversion fees will be charged if the change involves an
increase in the number of subjects over that of the original enrolment.
9.
It is the responsibility of the student to ensure that he / she fully
complies with the requirements and does the necessary examination
registration with the relevant University / Examining body. In this
respect, East Coast Maritime Academy will endeavour to assist the
student in whichever way necessary. The student will be charged
separately for these services.
10.
All representation made by the Academy regarding the awarding
University / Examining body and the external programme are based
on information made available by the University / Examining body and
are comprehensively contained in East Coast Maritime Academy
printed information or in Academy website. As the university reserves
the right to change programme details without any notice to the
student, Academy shall not be liable for any representations made
about the University / Examining body which will therefore not be
deemed as a term of enrolment.
11.
East Coast Maritime Academy reserves the right to cancel a course on
two weeks' notice prior to the commencement date of the course
whereupon any fees paid will be refunded in full.
12.
Academy reserves the right to withdraw a subject up to four weeks
after commencement date. If it is considered that the subject is not
viable whereupon an alternative subject will be offered or a pro-rated
refund of the course fees given.
13.
Academy also reserves the right to vary the subjects offered, the
timetable programmes scheduled and teaching staff so as to provide
better services to the students or as may be required by the
University/ Examining body or by the Ministry of Education.
____________________________
Parent / Guardian’s Signature
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
14.
All Notes/ hand outs, class video tapes and other materials given to
students are the intellectual property of East Coast Maritime Academy
and are given to registered students of the class as consideration for
enrolment who agree to respect the intellectual property rights of the
Academy.
15.
By Becoming the Student of East Coast Maritime Academy / signing
the application, you are termed to have accepted with free and full
consent all the agreements and contract between you and the
academy. And that you have also agreed and accepted all contracts
and agreements concluded between East Coast Maritime Academy and
Other Institutions / Companies, for the betterment of the course for
which you have registered yourself.
16.
This training is not meant for 'JOB', this is for a “CAREER “and the
student is expected to pursue this career for best results - Post
Graduate Diploma, Advance Diploma and Diploma Programs - East
Coast Maritime Academy conducts its own programs in Shipping &
Logistics and in other related sectors.
17.
We do not teach any Foreign Institute courses. These Courses does not
come under the purview of AICTE.
18.
In case the student discontinues the course at any stage or he / she
been dismissed from the course, the fees once paid by him / her will
not be refunded. If the student is paying the fees in parts, then only
after the payment of full fees of the course he / she shall be relieved
from the course.
19.
Admission to the course is subject to satisfactory performance Online
Entrance Examination and Interview conducted by the Academy at
Visakhapatnam and the right of admitting a student in a course is
reserved to the academy.
20.
The Student, by filling and duly signing the application, states and
declares his/her consent to abide by all the rules and regulations
framed by the institution which may be amended from time to time for
the betterment of the course /student community.
____________________________
Parent / Guardian’s Signature
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
21.
The institution reserves the right to make new policies and take
decisions at any time for the betterment of the course / student
community.
22.
The student is expected to follow utmost discipline both inside and
outside the campus, failing which he / she shall be liable to be
dismissed from the course immediately.
23.
East Coast Maritime Academy will deal with the current batch
students only when the students are in formal attire like uniform with
tie, shoes and ID card from Monday to Friday. On Saturday smart
casuals with ID card and shoes may be allowed.
24.
Minimum attendance required by the Academy is 90%.
25.
Any student whose Attendance is Less than 90% but above 60% shall
pay a condonation Fee of Rs.500/- (Rupees Five hundred only) for
every 1% shortage.
26.
Any student having less than 60% attendance but, above 50% shall
pay a condonation fee of Rs.1000/-(Rupees one thousand only) for
every 1% shortage.
27.
East Coast Maritime Academy reserves right of admission to the
courses/ programmes
28.
Students are to: a. Attend mandatory pre-finals exams for internal
marks, failing which students have to regularize by remitting Rs.
1000/- for each paper b. To remit a fee of Rs. 3,500/- towards 2 sets of
uniform material and shoe c. No student shall be allowed to enter the
classrooms without Academy uniform, ID card and formal shoes.
29.
Usage of mobile phones inside the classrooms is strictly prohibited.
Smoking and Drinking in the Hostel are strictly prohibited.
____________________________
Parent / Guardian’s Signature
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
Annexure – 2
Declaration by the Student
I,………………………………………….......Son/Daughter of……………………….
Residing at (Completed Postal address and Phone Number)…………………..
……………………........…………………………………………………………………..
………………………………………………..………………………………………………
………………………………… Solemnly affirm and undertake the following:
1. I, having got admission in “East Coast Maritime Academy”, shall
undergo the program of study as a responsible and disciplined student.
2. I am applying on my own and I have been adequately briefed about the
Vocational Training Programs, applicable fees, Rules and Regulation and
other information pertaining to my study. I have fully prepared myself
accordingly.
3. I am aware and have fully understood all the rules and regulations,
codes and practices of the Academy and shall strictly adhere to the Rules
and regulations that are in force in the Academy.
4. I shall not indulge in any act of indiscipline, misbehavior, unethical,
immoral, anti-social, anti-national or criminal activities during my entire
period of study at your Academy.
5. I shall pay all the applicable fees which include tuition, accommodation,
food, examination fees, academic expenses and other miscellaneous fees
related to my studies, on the prescribed dates, during my entire period of
study.
6. I am aware that, in the eventuality of not adhering to or acting in
violation of any one of the above undertakings, at any point of time
during my study period, I shall forfeit my admission. Neither I nor my
parents shall recover any sort of damages from the Academy. I shall also
immediately arrange to leave the Academy to my home town on my own
expenses.
7. Also, I hereby declare that I have not been expelled or debarred from
admission in any institution on account on being found guilty of,
abetting or being part of a conspiracy to promote ragging or due to any
other reason; and further affirm that, in case the declaration is found to
be untrue, my admission is liable to be cancelled.
____________________________
Parent / Guardian’s Signature
_______________________________
Student’s Signature
East Coast Maritime Academy
(An Institute of Shipping & Logistics for Vocational Training)
Door No. 25-12-35/2, Indu Mansions, Flat No. 404, 4th Floor, Godeywari Street, Visakhapatnam-1.
Tel: +91 891 6692 017 / 6630 782, Fax : +91 891 2521 191. www.eastcoastmaritimeacadimy.com
Email: [email protected] / [email protected]
(To be typed in Non-Judicial Stamp Paper as per the State Rules)
Annexure – 3
To
The Principal,
East Coast Maritime Academy,
Visakhapatnam.
Dear Sir,
Indemnity for Personal Safety
This is to state that I,………………………………………………………………………
Son of …………………………………………………………………………………………
have joined the Diploma / Advance Diploma / PG Diploma course, on my
own accord and I am aware of the personal safety aspects to be maintained
while under training. I agree to abide with the rules of the Academy and will
keep myself updated with any alterations to rules in the future during the
tenure of my training.
In particular I assume all risk and expenses towards personal injury, loss of
life, hospital, medical expenses, loss or damage of property or any other loss
or damage whatsoever and howsoever caused.
I confirm that I shall maintain strict discipline and adhere to all safety
procedures during my training at the Academy, and at any other location I
may be sent to for further training, for the course.
I will not hold EC Maritime Academy or any staff thereof responsible for any
injury that I may suffer due to any breach of this undertaking.
I expressly agree that the ECMA or any other Organization involved in the
training shall not be held responsible notwithstanding any express or
implied condition or warranty to the contrary, statutory or otherwise.
I declare that I am in sound health to undertake the above Course in all
aspects and I will not hold the Academy responsible for any hidden /
undisclosed medical reports and health conditions.
____________________________
Parent / Guardian’s Signature
_______________________________
Student’s Signature