APPLICATION NO. : - 08 R.L.INSTITUTE OF NAUTICAL SCIENCES TVR Nagar, Aruppukottai Road, Madurai - 625 022 Tamilnadu Ph: 0452-391 8615 Fax : 0452-391 8618 SAIL TO PROSPER Off-campus Centre of Birla Institute of Technology and Science (BITS), Pilani REGISTRATION FORM FOR ON-LINE TEST Name of the Candidate :... Father s Name :... Date of Birth :... PHOTO Address for Communication :...... Ph.. :... E-mail :... ON LINE TEST - CENTRE CHOICE FIRST CHOICE SECOND CHOICE (From Column A only) (From either Column A or B) Place: Date : Signature of the candidate Please see over leaf for list of Test centres APPLICATION NO. : - 08 R.L.INSTITUTE OF NAUTICAL SCIENCES TVR Nagar, Aruppukottai Road, Madurai - 625 022 Tamilnadu Ph: 0452-391 8615 Fax : 0452-391 8618 SAIL TO PROSPER Off-campus Centre of Birla Institute of Technology and Science (BITS), Pilani REGISTRATION FORM FOR ON-LINE TEST Name of the Candidate :... Father s Name :... Date of Birth :... PHOTO Address for Communication :...... Ph.. :... E-mail :... ON LINE TEST - CENTRE CHOICE FIRST CHOICE SECOND CHOICE (From Column A only) (From either Column A or B) Place: Date : Signature of the candidate Please see over leaf for list of Test centres
RLSAT 2008 1. The exact locations for RLSAT 2008 will be finalised and announced to candidates individually through Hall Tickets, alongwith the full address of centres. 2. Details will also be announced through our website www.rlinstitutes.com 3. Candidates are required to give 2 choices in the Registration Form. Sl.. Test Centre Column - A 1 BANGALORE 2 CHENNAI 3 HYDERABAD 4 KOLKATA 5 MADURAI (AT INSTITUTE) 6 MUMBAI 7 NOIDA LIST OF TEST CENTRES Sl.. 1 BHOPAL Test Centre Column - B 2 BHUBANESWAR 3 CALICUT 4 CHANDIGARH 5 DEHRADUN 6 GOA 7 GUWAHATI 8 JAIPUR 9 KOCHI 10 LUCKNOW 11 LUDHIANA 12 NAGPUR 13 RANCHI 14 SHIMLA 15 VISAKHAPATNAM RLSAT 2008 1. The exact locations for RLSAT 2008 will be finalised and announced to candidates individually through Hall Tickets, alongwith the full address of centres. 2. Details will also be announced through our website www.rlinstitutes.com 3. Candidates are required to give 2 choices in the Registration Form. Sl.. Test Centre Column - A 1 BANGALORE 2 CHENNAI 3 HYDERABAD 4 KOLKATA 5 MADURAI (AT INSTITUTE) 6 MUMBAI 7 NOIDA LIST OF TEST CENTRES Sl.. 1 BHOPAL Test Centre Column - B 2 BHUBANESWAR 3 CALICUT 4 CHANDIGARH 5 DEHRADUN 6 GOA 7 GUWAHATI 8 JAIPUR 9 KOCHI 10 LUCKNOW 11 LUDHIANA 12 NAGPUR 13 RANCHI 14 SHIMLA 15 VISAKHAPATNAM
F/03.001/1 Application. : - 08 R.L. INSTITUTE OF NAUTICAL SCIENCES (RLINS) TVR Nagar, Aruppukottai Road, Madurai - 625 022, Tamilnadu Ph : 0452-391 8615 Fax : 0452-391 8618 website : www.rlinstitutes.com e-mail : rlins@rlins.in Approved by Directorate General of Shipping, Government of India AN OFF-CAMPUS CENTRE OF BIRLA INSTITUTE OF TECHNOLOGY & SCIENCE (BITS) Pilani - 333 031, RAJASTHAN website : www.bits-pilani.ac.in APPLICATION FORM PLEASE INDICATE WHICH PROGRAMME YOU WOULD PREFER TO JOIN (IN THE SPACE PROVIDED PLEASE FILL IN FIRST CHOICE OR SECOND CHOICE ) B.S. (MARINE ENGINEERING) B.S. (NAUTICAL TECHNOLOGY) [Application form should be filled in Block Letters by candidate s own handwriting. All communication should be addressed to the Principal, quoting application number.] Applicant s most recent Photograph (3.5 cm X 4.5 cm) should be affixed here I PERSONAL PARTICULARS 1. NAME OF THE APPLICANT (IN CAPITALS) :... 2. FATHER S NAME : 3. DATE OF BIRTH (in Christian era) : Date Month Year 4. PLACE OF BIRTH : City / Town / Village :... District :... State :... PIN : 5. NATIONALITY : INDIAN N.R.I. OTHERS If OTHERS, then specify... 6. RELIGION :... 7. ADDRESS FOR COMMUNICATION :... PIN : Ph [STD Code] [...] [...] Mobile :... E-mail :...
[2] II ACADEMIC RECORD Secondary / 10th Standard English Total Marks % Marks % Examining Board FOLLOWING DOCUMENTS TO BE ENCLOSED ALONG WITH THE APPLICATION FORM 1. Attested copy of Secondary / 10th Std. (SSLC) Mark statement : 2. Attested copy of Certificate in support of your date of birth : III ANSWER THE FOLLOWING QUESTIONS 1. How did you come to know about RLINS? Through Institute Website Through BITS / Pilani Brochure Through Newspaper Advertisement Through Counsellor Through Friends / Relatives Through students of RLINS 2. Are you aware of our fee structure? 3. How do you propose to arrange funds to pay the required fees? Self Arrangement Bank Loan ANNEXURE - I of this Application to be submitted when the Senior Secondary / +2 marks are available DECLARATION I hereby declare that the information furnished above are true and correct to the best of my knowledge. I shall abide by the rules and regulations of the institute in force and as may be amended from time to time with regard to discipline, fee structure, etc. I hereby declare that I am fully aware of the declaration made by the applicant - my son / ward and I declare and bind myself on the same terms contained in the above declaration. The information furnished are true, correct and complete. Place : Date : Signature of the candidate Place : Date : Signature of the Parent / Guardian
TO BE FILLED BY THE CANDIDATE AND SUBMITTED ALONGWITH SENIOR SECONDARY / +2 MARK RESULTS ANNEXURE - I Sheet 1 of 2 Name :... Application. : - 08 ACADEMIC RECORD Secondary / 10th Standard English Total Marks % Marks % Examining Board Senior Secondary / 10+2 Standard Marks obtained Examining PCM Aggregate Physics Chemistry Maths English Board % Name and Address of the School : studied in Senior Secondary / 10+2... PIN : Ph [STD Code] [...] [...] E-mail :... FOLLOWING DOCUMENTS TO BE ENCLOSED ALONG WITH THE APPLICATION FORM 1. Attested copy of Secondary / 10th Std. (SSLC) Mark statement : 2. Attested copy of Senior Secondary / 10+2 Mark statement : 3. Attested copy of Certificate in support of your date of birth : 4. Attested copy of Conduct certificate : 5. Attested copy of Transfer Certificate :
ANNEXURE - I Sheet 2 of 2 DECLARATION BY THE CANDIDATE I hereby declare that the information furnished above are true and correct to the best of my knowledge. I shall abide by the rules and regulations of the institute in force and as may be amended from time to time with regard to discipline, fee structure, etc. Place : Date : Signature of the candidate DECLARATION BY THE PARENT / GUARDIAN I hereby declare that I am fully aware of the declaration made by the applicant - my son / ward and I declare and bind myself on the same terms contained in the above declaration. The information furnished are true, correct and complete. Place : Date : Signature of the Parent / Guardian FOR OFFICE USE Name of the Candidate Regn.. Application received on Interview on Is application complete in all respects? YES NO If not indicate the item number which needs correction / clarification Date : Administrative Officer If the candidate is admitted indicate by putting mark here Date : Principal
INFORMATION TO CANDIDATES ============================== PROCEDURE TO GET THE APPLICATION I. For the candidates who want to get the application from the Institute / Counselor Initial Processing Fee : Rs.100/- to be paid by the candidate at the time of getting the application form. Final Processing Fee: Rs.700/- to be paid by the candidate in the form of Demand Draft drawn in favour of R.L. INSTITUTE OF NAUTICAL SCIENCES, payable at Madurai at the time of submission of Application Form. (Filled in application without demand draft of Rs.700/- will not be processed) II. For the candidates who download the application from the website Candidate can download the application from our website. The filled in application to be submitted directly to the institute alongwith a demand draft of Rs.800/- drawn in favour of R.L. INSTITUTE OF NAUTICAL SCIENCES, payable at Madurai towards one time processing fee. APPLICATION SUBMISSION PROCEDURE First Stage Second Stage Initially Candidate is required to submit the filled in application alongwith Registration form for on-line test enclosing Secondary / X Std Mark List. This can be done even before the Senior Secondary / +2 results. After the publication of Senior Secondary / +2 results Candidate is required to submit Annexure-1 of the application form duly incorporating the marks obtained in Senior Secondary / +2 examination enclosing the attested copies of the mark list. A. Last date for submission of filled in application form alongwith X mark sheet and for On-line Test Registration. i. At National Centres including Institute Centre 30.04.2008 ii. At Institute Centre only 20.06.2008 B. Last date for submission of Senior Secondary / +2 mark sheet (Annexure-I with attested copy of mark sheet) 25.06.2008..2
[2] APPLICATION PROCESSING / ADMISSION PROCEDURE On Line Test & Provisional Admission Once the Institute receives the first stage of applications from the candidates alongwith the Registration Form for On Line Test, the application will be processed. Hall tickets indicating the date and venue of the On Line Test will be issued to the candidates. Candidates can download their Hall Tickets from our site. Once the institute receives the Annexure-1(2 nd stage of applications) from the candidates alongwith the Senior Secondary / +2 mark results the applications will be processed. Based on the performance in on-line test, Senior Secondary results, eligibility criteria and medical fitness, the provisional admission letters will be issued to the successful candidates. Admission will be confirmed upon payment of First Semester fees and production of original documents. ********