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5/27/2017 UntitledDocument

Rev.Aug.06
PILOT PILOT CA9(PILOTCompt.No)
GOVERNMENTOFINDIA
DIRECTORATEGENERALOFCIVILAVIATION,
CENTRALEXAMINATIONORGANISATION Pasterecent
passportsize
ApplicationforAllotmentofCOMPUTERNUMBER photograph

(WITHOUT
Note:Allcorrespondenceregardingwrittenexaminationincludingdulyfilledinapplicationforms ATTESTATION)
forcomputerno./writtenexaminationshouldbeforwardedto

DIRECTOROFAIRWORTHINESS(CEO)
O/OTHEDIRECTORGENERALOFCIVILAVIATION
Putyourspecimen
EASTBLOCKIII,R.K.PURAM,NEWDELHI110066. signatureintheabove
spaceINBLACKINK




TemporaryIdPTEMP17/0613037
Candidate'sName MrSREERAGS
Gender Male
Father'sName SURESH
Mother'sName SREEDEVIP
DateOfBirth 09071997
EmailId ssreerags06@gmail.com
Nationality INDIAN
Country INDIA
PassportNumber NA
PassportValidity NA
PERIMGATTOMPALLIL,MATTOMNORTHTHATTARAMBALAMPO,
PermanentAddress
MAVELIKKARA,KERALA,PIN690103
PERIMGATTOMPALLIL,MATTOMNORTHTHATTARAMBALAMPO,
MailingAddress
MEVELIKKARA,KERALA,PIN690103
ApplyingFor CPL
Qualification 10+2[withPhysicsandMaths]
DefencePersonnel No
DefenceCategory NA
WhetherhavingSPLornot? No
DateOfIssueOfSPL NA
WhetherhavingHigherCategoryPilot
No
License
LicenseCategory NA
LicenseNumber NA
LicenseValidity NA
EndorsementOfMultiEngineAircraft No
DateOfFirstTrainingFlight
TotalFlyingHours
TotalFlyingHoursasPilotInCommand
FlyingTrainingInstitute
GroundTrainingInstitute

http://udaan.nic.in:8080/udaan/applicantForm.do 1/2
5/27/2017 UntitledDocument

Enclosures:...............................................................................................................................................
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Iherebycertifythattheaboveparticulars/entriesmadebymearetrueandcorrectineveryrespecttothebestofmy
knowledgeandbeliefandthatnothinghasbeenconcealedorwithheldbyme.Iunderstandthatifanyofmyparticulars/entries
arefoundfalseorincorrectatanytime,mycandidaturewillstandrejectedandfurtheractioncanbetakenagainstmebyDGCA
aspertherules.Further,ihavereadtherequirementforissueextensionofPilots'Licence/Rating,aslaiddowninAircraftRules
/CARsamendedfromtimetotime.

Date:____________________Signatureofapplicant:______________________________________

CERTIFICATIONBYATTESTINGOFFICER

(TobeattestedbyCFI/PII/GazettedOfficer.IncaseofservingDefencepersonnel,thismay
beattestedbyanotherservingCommissionedOfficer)
Applicantshould
pasterecent
ThisistocertifythatalltheaboveparticularsfurnishedbyMr.SREERAGShavebeen passportsize
verifiedbymeandfoundtobecorrect. photograph

*Signatureinfullofattestingauthority........................................

Date&Place..................................*Signature&stampshallpartlycoverthispageand
photograph

PILOT PILOT PILOT


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