Student Enrolment Form_ANAC

STUDENT APPLICATION FORM FOR ENROLLMENT

PLEASE COMPLETE IN BLOCK LETTERS
FULL NAME*

PrefixFirst NameLast Name
DATE OF BIRTH*

DayMonthYear
Date
AGE*
in YEARS
CONTACT NUMBER*
EMAIL ADDRESS*
PASSPORT NO.*
RESIDENTIAL ADDRESS*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
POSTAL ADDRESS (if same as above, not required)

Street Address

Street Address Line 2

CityState

Zip CodeCountry
NEXT OF KIN*
TRAINING REQUIREMENTS (DIPLOMA OF AVIATION)*
DETAILS IN CASE OF INJURY
PASSPORT FRONT PAGE*
PASSPORT BACK PAGE*
DECLARATION (TO BE FILLED BY THE STUDENT)

I , Full Name*
Hereby make APPLICATION for Enrolment at AUSTRALIAN NATIONAL AIRLINE COLLEGE, AUSTRALIA & COSMOI PILOTSASSIST SERVICE PRIVATE LIMITED, INDIA as indicated above. The training fees for DGCA-INDIA CPL Training in Australia is Rs 63 Lakhs.

SIGNED AT Time*   ON Date* .

SIGNATURE OF APPLICANT   Signature*

WITNESS 1   Full Name*     WITNESS 2 Full Name*
STATEMENT OF ACKNOWLEDGEMENT*
Please verify that you are human*
Should be Empty: