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: ETO2167527
 
Full Name (as per Passport) : Kaushikkumar Ramesh Patel
Date of Birth (DD/MM/YY): 18 Sep 1995 Nationality: INDIAN
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: U1048246 Date of Expiry: 24 Oct 2029
Place of Issue: DAMAN Personal Identification Mark: Moles on forehead

(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.: House no 35
Street /Lane: Ghelwad Falia
Village / Post Office / Tehsil: Dabhel
City / District: Nani Daman
State: Gujarat
PIN: 396210
Telephone No. with STD code: Mobile: 7874267999
E-mail: kp488823@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2011 Year of Passing: 2013
Board: CBSE Board: CBSE
English %: 70 English %: 57
Aggregate Percentage: 70 Aggregate Percentage: 66
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 71 71
Chemistry 100 82 82
Mathematics 100 53 53
English 100 57 57
Physics, Chemistry & Mathematics combined Percentage: 68.67
   
   

Diploma:

Graduation:
Diploma Specialization: Degree Specialization: Electrical Engineering
Name of Polytechnic: Name of College: Parul University
Tel. No.: Tel. No.: 9099008875
Email Id.: Email Id.: kp488823@gmail.com
Board: University: GTUĀ 
Year of Joining:
Year of Joining: 2013
Year of Passing: Percentage: Year of Passing: 2017 Percentage: 76
Medium of Instruction: Medium of Instruction: Gtu

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
Vital lab Trainee Engineer    
    16 Sep 2020  
       
 
What are your hobbies ? Cooking, playing football
What are your strengths ? Honest
What are your weaknesses ? Become friend easily
 
 
Declaration

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

Signature of Candidate

 

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Date ________________