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: ETO2167477
 
Full Name (as per Passport) : shubhangi mahadev gaikawad
Date of Birth (DD/MM/YY): 02 Dec 1997 Nationality: Indian
Gender (M/F): Female Marital Status (Single/Married): Single
Passport No.: Date of Expiry:
Place of Issue: Personal Identification Mark: mole on nech

(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.: 123
Street /Lane: near gosavinath temple
Village / Post Office / Tehsil: vadarage, gadhinglaj
City / District: kolhapur
State: Maharashtra
PIN: 416502
Telephone No. with STD code: Mobile: 8482966878
E-mail: gaikawadshubhangi1@gmail.com  
 

Academic Record -

  
Class X: - Class XII: -
Year of Passing: 2014 Year of Passing: 2016
Board: Maharashtra Board: Maharashtra
English %: 73 English %: 53
Aggregate Percentage: 91 Aggregate Percentage: 71
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 66 66
Chemistry 100 64 64
Mathematics 100 83 83
English 100 53 53
Physics, Chemistry & Mathematics combined Percentage: 71
   
   

Diploma:

Graduation:
Diploma Specialization: Degree Specialization: Electrical Engineering
Name of Polytechnic: Name of College: Sant gajanan Maharaj college of Engineering Mahagaon
Tel. No.: Tel. No.: 02327275581
Email Id.: Email Id.: sgmcoe@gmail.com
Board: University: shivaji university 
Year of Joining:
Year of Joining: 2016
Year of Passing: Percentage: Year of Passing: 2020 Percentage: 72
Medium of Instruction: 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 ? planting, photography
What are your strengths ? positive attitude, self confident, hard working
What are your weaknesses ? i cant sleep until my work is not complete.
 
 
Declaration

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

Signature of Candidate
 

___________________
 

Date ________________