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Liasion Officer Application Form

The document is a Liaison Officer application form filled out by an individual named Mohit Maan from Belgium, with personal and academic details provided. It includes information on language proficiency, mountaineering qualifications, and experience in expeditions. The applicant declares their medical fitness for mountain climbing and confirms they are not connected with any tour operator or have any police convictions.

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sharunjitglobal
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14 views1 page

Liasion Officer Application Form

The document is a Liaison Officer application form filled out by an individual named Mohit Maan from Belgium, with personal and academic details provided. It includes information on language proficiency, mountaineering qualifications, and experience in expeditions. The applicant declares their medical fitness for mountain climbing and confirms they are not connected with any tour operator or have any police convictions.

Uploaded by

sharunjitglobal
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Liasion Officer Application Form

Personal information
Application ID: 4 User ID: as10
First Name: mohit Last Name: maan
Father's Name:: ma
Nationality: Belgium
Whether Employed ?: maan Organization Name: null
Monthly Income: N Designation: null
Next of Kin: s Relation with Kin: s
Academic Qualfications: BETWEEN 6TH AND 9TH CLASS
Email: dd@[Link] Phone Number: 933
Address:

Other details
Language Proficiency :
Language Speak Read Write
English Y Y Y
Hindi Y Y Y
Panjabi Y Y N
French Y N N

Mountaineering and Allied Qualfications


Course Institute Course NoMonth & Year GradingRemarks
Basic XYZ 2000 Dec-2015 A-2 fgfgghh
Advanced XYZ 2001 Jan-2016 A-2 htytyty
Lo Course XYZ 2010 Jul-2016 B-1 ddy
Lo Course Advanced XYZ 2020 Sep-2016 B-2 ddy

Mountaineering Experience
Year Expedition Peak Route
2011 Expedition to Shivling Shivling (Uttarakhand a to d
2013 Expedition to Bhagirathi-II Bhagirathi-I (Uttarakhand a to d

Preferred Season: pre Preferred month From: jan To: feb


Reason for preferred peak: good peak
Height: 20.0 Boot Category: EU Boot Size: 8
Tour agent connection: 20.0 Police convicted: dd@[Link] Application request Date: dd@[Link]

(a)The above information given by me is correct to the best of my knowledge and belief. dd@[Link]
(b) I am medically fit for mountain climbing above 6000 Mts. (20000ft approx). dd@[Link]
(c) I am NOT connected with any Tour Operator or Travel Agent. dd@[Link]
(d) I have never been convicted in any police case. dd@[Link]

Declaration

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