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)

APPLICATION FOR ADMISSION - March 2021


Application Summary
 
Dossier ID: ETO2167424 Name: FOUZAN C
  Address: CHANGARANCHOLA HOUSE CHERUSHOLA P.O
Telephone No.: Mobile no: 8078373736
E-mail: fouzanfc@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: -
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID ETO2167424 are true and correct.
Signature of Candidate Signature of Parent/Guardian
   
   

___________________

___________________

   
Date ________________ Date ________________
 

 

Please quote your dossier id and full name for any future correspondence
Please check that the following documents are accompanying this application :
  1. Three identical recent passport size photographs (including one attached on the form)
  2. Attested Copies of Class X, XII mark sheet, Age Proof
  3. Attested Copies of Graduation Semester/ Year wise Grade Sheet
  4. Attested Copies of Graduation Certificates
  5. Format of Annex-1 to be printed on college/institute letterhead and submitted along with application form
  6. CGPA / DGPA to percentage conversion letter (if applicable)
  7. Print the application form duly filled
  8. Send the hard copy of application form along with necessary documents to TMI, Induri
  9. Send filled application forms to Admissions Cell (ETO), Tolani Maritime Institute, Induri Village, Talegaon Chakan Road, Talegaon Dabhade, Pune, PIN- 410507

     
     

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)

APPLICATION FOR ADMISSION - March 2021

Dossier ID: ETO2167424
 
Full Name (as per Passport) : FOUZAN C
Date of Birth (DD/MM/YY): 21 Oct 1996 Nationality: INDIAN
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: U2853324 Date of Expiry: 08 Dec 2030
Place of Issue: MALAPPURAM Personal Identification Mark: SCAR ABOVR RIGHT EYE

(Note: If you do not have passport, you may apply for it as early as possible as passport is required for obtaining Seaman’s Discharge Certificate, mandatory for boarding a ship.)

Addresses & Contact Details -

House / Building No.: CHANGARANCHOLA HOUSE
Street /Lane: CHERUSHOLA P.O
Village / Post Office / Tehsil: SWAGATHAMADU
City / District: MALAPPURAM
State: Kerala
PIN: 676510
Telephone No. with STD code: Mobile: 8078373736
E-mail: fouzanfc@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2012 Year of Passing:
Board: CBSE Board:
English %: 76 English %:
Aggregate Percentage: 79 Aggregate Percentage:
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics
Chemistry
Mathematics
English
Physics, Chemistry & Mathematics combined Percentage:
   
   

Diploma:

Graduation:
Diploma Specialization: Electrical and Electronics Engineering Degree Specialization: Electrical and Electronics Engineering
Name of Polytechnic: MADIN POLYTECHNIC COLLEGE MALAPPURAM Name of College: COLLEGE OF ENGINEERING TRIVANDRUM
Tel. No.: 9142112927 Tel. No.: 04712515502
Email Id.: principal.mptc@madin.edu.in Email Id.: principal@cet.ac.in
Board: STATE BOARD OF TECHNICAL EDUCATION KERALA University: APJ ABDUL KALAM TECHNOLOGICAL UNIVERSITY 
Year of Joining: 2014
Year of Joining: 2017
Year of Passing: 2017 Percentage: 87 Year of Passing: 2020 Percentage: 74
Medium of Instruction: ENGLISH Medium of Instruction: ENGLISH

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 ? Photography, Travelling
What are your strengths ? A good listener and interested in developing new skills. Good at volunteering and conducting events.
What are your weaknesses ? A little addicted to phone usage.
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________

 
Print Summary and Application Form