Application Form

For Official Use Only :-

Application Form No.:- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Registration No.:- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

To be filled by candidates :-

* Name in Full (Capital Letters)

* Fathers Name

* Occupation

* Present Correspondence Address

* Mobile Number

Landline number with STD code

* Date of Birth (DD/MM/YYYY)

* Educational Qualifications

* Application form for admission in .. Advance Diploma in Industrial Safety (IT) (1 Year) Diploma in Fire Service Engineering (FR) (2 Years) MBA in Fire Safety and Hazard Management M.Sc. in Disaster Management M.Sc. in Environment Science B.Sc. in Environment Science PGD in Fire Safety and Hazard Management (PGDFSHM) B.Sc. in Fire Safety and Hazard Management (BSCFSHM) Advance Diploma in Fire Safety and Hazard Management (ADFSHM) Diploma in Fire Safety and Hazard Management (DFSHM) Diploma in Fire Safety Engineering (Proficiency) Fire Technology & Industrial Safety Management Certificate in Security and Fire Prevention Training Certificate in Industrial Safety Management Training

Physical Standards :-

* Height (165 cm)

* Weight (50 Kg)

* Chest Size Min. (81 cm)

* Max (86.5 cm)

• No colored glass and No physical deformities
• Medical Fitness Certificate from Registered Medical M.B.B.S. Doctor.

* Date (DD/MM/YYYY)

* Place

Declaration :- (By the Candidate / Applicant)

Certified that I shall abide by the Institute rules and regulation, all payments of dues shall be made in time. I do herby promise not to take part in political subversive and agitational activities. In case I am involved in any of these activities, I shall abide by the action taken by the Institute authorities. All the particulars stated above are correct. I shall be regular and shall attend minimum of 75% of the lectures delivered and shall appear in internal or sessional examination/tests etc. failing which I shall have no claim if my admission to the Examination is withheld. I know that the fees once paid to the Institute are not refundable or transferable under any circumstances and I shall not ask for refund, even in the event of cancellation of the admission by me or by Institute. I shall pay full amount of fees on cancellation of admission or request for the original documents. I am aware that above mentioned courses are recognised by MSBTE / TGOU.

Declaration :- ( By the Father / Guardian)

is seeking admission in your Institute with my permission and I promise to pay all dues regularly as and when demanded. In case of expulsion of admission from the Institute for breaking the rules I will not ask for refund of fees even in the event of cancellation of admission by me or by Institution. He will not take part in any political subversive and agitational activities. In case he is involved in any of these activities I shall abide by the action taken by the Institute authorities. I undertake the responsibility of good behavior and conduct of my Son / Ward during the course of his stay in the Institution. I shall pay full amount of fees on cancellation of admission or request for the original documents. I am aware that above mentioned courses are recognised by MSBTE / TGOU.

* Address of Father/Guardian

Documents to be submitted at the time of Admission :-

1. Two passport size unsigned photographs
2. All original eligibility documents / certificates along with two photo copies duly attested.
3. A copy of character certificate and police verification certificate from Police Station.
4. Medical fitness certificate