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: ETO2167576
 
Full Name (as per Passport) : Kaushil Shriyan
Date of Birth (DD/MM/YY): 06 Mar 1998 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: Date of Expiry:
Place of Issue: Mangalore Personal Identification Mark: Mole on right 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.: Punya
Street /Lane: Acharya lane
Village / Post Office / Tehsil: Surathkal
City / District: Mangalore
State: Karnataka
PIN: 575019
Telephone No. with STD code: Mobile: 9845228930
E-mail: kaushilshriyan14@gmail.com  
 

Academic Record -

  
Class X: - Class XII: -
Year of Passing: 2014 Year of Passing:
Board: CBSE Board:
English %: 84 English %:
Aggregate Percentage: 84 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: Degree Specialization: Electrical and Electronics Engineering
Name of Polytechnic: Name of College: St Joseph Engineering college Vamanjoor
Tel. No.: Tel. No.: 08242263753
Email Id.: Email Id.: sjec@sjec.ac.in
Board: University: VTU 
Year of Joining:
Year of Joining: 2016
Year of Passing: Percentage: Year of Passing: 2020 Percentage: 65
Medium of Instruction: Medium of Instruction: Electrical

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 ? Stock market trader
What are your strengths ? Quick learner of electrical and electronics
What are your weaknesses ? Communication
 
 
Declaration

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

Signature of Candidate
 

___________________
 

Date ________________