1. Batch & Year in which stuided* : Batch      Year 
2. Name* :
3. Permanent Residential Address* :
  Upload Photo :
  Contact Telephone Number*
(Both Land Line & Mobile) 		:
  Email Id* :
4. Age* : Date Of Birth* :   
5. a) Marital Status : Married Unmarried
  b) Give Date Of Wedding if Married :   
6. Present CoC and Rank Held*
    a) Coc :
    b) Rank :
    c) Name Of The company sailing with :
7. Companies sailed with in previous ranks , as applicable*
    a) 5THEngineer :
    b) 4THEngineer :
    c) 3RDEngineer :
    d) 2NDEngineer :
    e) Chief Engineer :
8. Any other additional qualification attained after leaving CSSM (If yes, give details as follows)
 
Sl.NO Exam Passed Year Of Passing Name of the College/University & state
1.
2.
3.
4.
       
9. Details of short-term courses completed
 
Sl.NO Name of course Duration Name of the College/University & Place
1.
2.
3.
4.
       
10. Whether member of IME(I) or any other
association (if yes, give details) 		:
11. CDC Number* :
12. Passport Number* :
13. INDos Number* :
14. Details of family members
 
Sl.NO Name of Person RelationShip Date of Birth
1.   
2.   
3.   
4.   
       
15. Signature* :
 
1. Any other suggestions, to improve Alumni Association.
2. Would you like to visit CSSM and give/conduct some seminars to the present cadets?
3. Reporting on line, i.e., through e-mail about any accident you have come across during your sailing.
     
 
     
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