Application Form

APPLICATION FORM FOR 2020

Please read the below instructions before filling the online application forms (Click here for Step by Step Guide)

I have read and understood the SIMS Eligibility Criteria & Prospectus

I am aware that if I do not meet the SIMS eligibility criteria, I will not be allowed to proceed to the stage of online test. Also, I will not be entitled to obtain any refund of the registration fees.

All information provided by me in the application form is true and complete in all respect. I am aware that any misrepresentation or omission of information made by me will be considered as a sufficient cause for withdrawal of my offer and dismissal from the course at any stage.

I am aware that I can apply only once for a particular batch and in case I try applying twice for the same batch I will not be allowed to attend the online test ; also I will not be entitled to obtain any refund of he registration fees.

I hereby confirm that I have adhered to the following declaration:

A.	I shall not engage in or participate in any business or be self-employment during my training at SIMS.
B.	I shall not misuse controlled drugs or take part in any political or other illegal activities during my stay in SIMS premise.
C.	I have not submitted any false statement or submitted any document which I know to be false in order to obtain the admission at SIMS
D.	I confirm that my candidature is purely on my merit and does not involve any recommendations.
E.	I have not bribed any one in ESM, SIMS, Agent, or outside agencies to get my admission at SIMS.

Course Selection

Please indicate the course you wish to apply for before proceeding to fill up the form:
The batch you wish to apply is:

Payement Mode Selection

Online Payment

Personal Information


Aadhar Card Number
First Name		Middle Name
Last Name		Date of Birth
Highest Qualification		Place of Birth
Marital Status		Citizenship
Height		Weight
Email		Contact No. / Mobile No.
Mailing Address		City
State		Pin
Gender
Passport Size Photo * Minimum size 200KB * Not exceeding 2MB
Father Name		Father's Occuptation
Annual Income of the Family (Includes income of earning members of the family)		Father's Contacts

Medical


Eye Sight		Colour Blindness
Major illness/ operations undergone before
If Yes, please provide details

(10th) Details


High School Name		Pass in first attempt
Address		City
State		Pin
Board
Year of Education : From		Year Of Passing
English	%	Aggregate	%

(12th) Details

College Name

Pass in first attempt

Roll Number of Board Examination

(* Please enter "NA" if you don't have the roll number)

Address

City

State

Board

Year of Education : From

Year Of Passing

Check here if you are still awaiting for the examination result :

Please choose either one of the following to fill:

Graduation Details (Optional, to be filled by candidates having BSc/ BE/ B Tech Degree)

College/Institute Name

Pass in first attempt

Address

City

State

University

Roll Number of University Examination

Stream

No. of ATKTs
(Total no. of addl attempts made to pass in all subjects)

Year of Education : From

Year Of Passing

Check here if you are still awaiting for the examination result :

Please choose either one of the following to fill:

Others

Preferred Choice of cities for online test:
Cities Available for Attending Online Test

How did you come to know about Samundra Institute of Maritime Studies, Lonavala?
(You may select more than one option.)

	Newspaper/Magazine			Facebook
	School/College			Family/Relatives/Friends
	Edu Fair/ Job fair			Emails sent by SIMS
	Directly contacted			www.Shiksha.com
	Internet			Talent Search Scheme Conducted in School / Town / City
	Others

Field Office: Help desk for candidates


Delhi ESM / SIMS Field Office	Chandigarh ESM / SIMS Field Office
Executive Ship Management Pte Ltd 502A, Rectangle -I , D-4, District Centre, Saket, New Delhi –110017 Tel: + 91-11-49882700 Fax: + 91-11-2956-2777 Mob: +91-8051807332 Email: admission.simsdelhi@samundra.com	Executive Ship Management Pte Ltd CVU- 1, Central Plaza, Sector 105 Mohali Hills, Banur Landran Road Greater Mohali Tel: +91-160-6667777 Mob: +91-6284456328 Email: admission.simschandigarh@samundra.com


Chennai ESM / SIMS Field Office	Cochin ESM / SIMS Field Office
Executive Ship Management Pte Ltd Batra Centre 1st Floor No. 28, Sardar Patel Road Guindy, Chennai 600032 Tel: + 91-484-4151777- 8 Fax: + 91-484-2367275 Mob: +91-9359632520 / 9673799827 / 9881554132 Email: admission.simschennai@samundra.com	ESM Complex, St. Ritas road Near Gold Souke, (Adjacent to BRM Lights/ Ambika Pillai) Ponnurunny, Vytilla Cochin - 682019 Tel: + 91-484-4151777- 8 Fax: + 91-484-2367275 Mob: +91-8943312890 Email: admission.simscochin@samundra.com


Mumbai ESM / SIMS Field Office	Kolkata ESM / SIMS Field Office
Executive Ship Management Pte Ltd Sai Commercial Annexe,BKS Devshi Marg 2nd Floor, Govandi Station Road Govandi (East) Mumbai ,Pin - 400088 Tel Nos : + 91-2114399517 Mob: + 91-9359632520 / 9673799827 / 9881554132 Email: admission.sims@samundra.com	Executive Ship Management Pvt. Ltd. Godrej Genesis, Unit No #503, 5th Floor Plot#11, Block E.P & G.P, Salt lake Sector V, Kolkata-700 091 Tel No: +91-612-3223692/612-3222622 Mobile No: +91-8051808332 Email : admission.simspatna@samundra.com


Patna ESM / SIMS Field Office
Executive Ship Management Pte Ltd 1st Floor, J.M. Complex, AS Colony, Bailey Road, Rupaspur, Patna Tel : +91-612-3223692/612-3222622 Mob: +91-8051808332 Email : admission.simspatna@samundra.com

Terms of Application

All related costs incurred as a result of the short listed applicant attending the interview, including cost of medical tests and psychometric test, shall be fully borne by the applicant himself.

The list of successful candidates who are accepted for SIMS pre sea training, would be announced in our website. These candidates are to submit a non-refundable joining fee (except for caution fee which will be refunded after adjusting any dues) as per the schedule date stated in our website. Those who pay the joining fee within the time frame, will only be accepted for admission.

Any dispute concerning the interpretation of any of the terms and conditions of admission or prospectus shall be resolved amicably. If the student(s) / candidate(s) / parent(s) and the institute failed to resolve the dispute amicably, then the matter should be referred to the sole arbitrator to be nominated by the institute. The award passed by the sole arbitrator shall be binding on both the parties. The place of arbitration shall be the institute's premises only and the provisions of arbitration and conciliation act, 1996 shall apply to the arbitration proceedings.

Jurisdiction clause: - All legal disputes are subject to Mumbai / Pune court only.

Declaration by the Applicant

I declare that all information provided in this form, is true and complete in all respect. I fully understand that any misrepresentation or omission of information may be considered sufficient for withdrawal of the offer and dismissal from the course at any time. I also agree to the terms set out in Terms of Application.

I confirm that the information as set out in this application were provided by me and that the said information is true and correct.

I understand that I may be subject to prosecution if I have provided any information, which is false in any material particular or is misleading by reason of the omission of any material particular.

Further I, declare:

1.	I shall not engage in or participate in any business or be self-employment during my training at SIMS.
2.	I shall not misuse controlled drugs or take part in any political or other illegal activities during my stay in SIMS premise.
3.	I have not submitted any false statement or submitted any document which I know to be false in order to obtain the admission at SIMS
4.	I confirm that my candidature is purely on my merit and does not involve any recommendations.
5.	I have not bribed any one in ESM, SIMS, Agent, or outside agencies to get my admission at SIMS.

I understand that if I breach any conditions above, during training at SIMS or even after training at SIMS, I will be subjected to:

1.	Prosecution in court
2.	Dismissal and pay all costs including Training fees if it is during training at SIMS prior employment onboard.
3.	Immediate dismissal from the ship and I agree to pay SIMS:-
	a. all the cost incurred for my repatriation
	b. all the costs incurred for my relievers joining ship
	c. all the costs incurred, including training fee for my pre-sea training at SIMS
	d. all the costs incurred for my post-sea training at SIMS

Samundra Institute of Maritime Studies
The Training Commitment of Executive Ship Management Pte Ltd
78 Shenton Way, #21-00
Singapore 079120
Tel : +65 6324 0500
Fax : +65 6324 4544
esm@executiveship.com
www.executiveship.com