Application for ETO Admissions -2019

Tolani Maritime Institute

Induri,Talegaon Dabhade, Pune – 410507
Tel.: 02114-669600/1, E-mail: info@tmi.tolani.edu, Web: www.tolani.edu
Electro-Technical Officers Course
(Pre-sea Training & Certification for Merchant Ships)

PERSONAL PARTICULARS:

First Name:

(In BLOCK LETTERS)

Last Name:

(In BLOCK LETTERS)

Date of Birth:

Nationality:

Gender:

Male
Female

Marital Status:

Single
Married

Passport No:

Date of Expiry:

Place of Issue:

Personal Identification mark:

(Note: If you do not have passport, you may apply for it as early as possible as passport is mandatory at the time of admission, if selected.)

Upload your photograph:

+ Add new file

Your photograph can only be in .gif, .jpg or .png format.

Addresses & Contact Details

House / Building No.:

Street / Lane:

Village / Post Office / Tehsil:

City / District:

State:

PIN:

STD Code:

Start STD code with zero.

Tel. No.

Mobile:

(Do not start with zero. For foreign numbers write the ISD code as part of the number.)

E-mail:

Enter a valid Email, The Email ID that you choose will enable you to communicate with TMI about your application.

ACADEMIC RECORD:

Class X:-

Year of Passing:

Board:

English:%

Aggregate percentage:

for all subjects

Class XII:-

Year of Passing:

Board:

English:%

Aggregate percentage:

for all subjects

Details of Marks Secured in (10+2) Examination:

Subjects

Maximum Marks

Marks Secured

Percentage (%)

Physics

Chemistry

Mathematics

Physics, Chemistry & Mathematics combined Percentage:

Please fill all fields of 12th, if done or do not fill any fields.

Diploma

(Only for candidates who have completed Degree after Diploma)

Diploma Specialization:

(Please specify):

"Certificate of Equivalence from university/college to be produced along with the application form"

Name of Polytechnic:

Tel. No.

Polytechnic E-mail Id:

Board:

Percentage:

Year of Joining:

Year of Passing:

Medium of Instruction:

Graduation:

Degree Specialization:

(Please specify):

"Certificate of Equivalence from university/college to be produced along with the application form"

Lateral Entry:

Name of College:

Tel. No.:

College E-mail Id:

University:

Percentage:

Year of Joining:

Year of Passing:

Medium of Instruction:

Note: Diploma/Degree courses must be recognised by any State or Central Government or the AICTE.

Other Qualification if any -

Work Experience if any -

Name of the Firm

Designation

From

To

What are your hobbies?:

What are your strengths?:

What are your weaknesses?:

PAYMENT INFORMATION:

Payment Mode:

DD Number:

Issuing Bank:

You are required to submit the letter as per attached format (Annex 1). for course recognized by State/ Central Government/ AICTE and their registration number. It is to be printed on college/institute letterhead and to be submitted along with your application form.

Declaration

I hereby declare that all the statements made above are true and correct.