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: ETO2167651 Name: Kishan Raj
  Address: AK Colliery Saunda Near Panchayat Bhawan
Telephone No.: Mobile no: 7011113214
E-mail: kishanraj7079@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 1200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 401487257
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID ETO2167651 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: ETO2167651
 
Full Name (as per Passport) : Kishan Raj
Date of Birth (DD/MM/YY): 26 May 1998 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: U3517058 Date of Expiry: 17 Jan 2031
Place of Issue: Ranchi Personal Identification Mark: A mole on right cheek

(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.: AK Colliery Saunda
Street /Lane: Near Panchayat Bhawan
Village / Post Office / Tehsil: Saunda C
City / District: Ramgarh
State: Jharkhand
PIN: 829126
Telephone No. with STD code: Mobile: 7011113214
E-mail: kishanraj7079@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2014 Year of Passing: 2016
Board: CBSE Board: CBSE
English %: 65 English %: 69
Aggregate Percentage: 68 Aggregate Percentage: 73
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 76 76
Chemistry 100 74 74
Mathematics 100 49 49
English 100 69 69
Physics, Chemistry & Mathematics combined Percentage: 66.33
   
   

Diploma:

Graduation:
Diploma Specialization: Degree Specialization: Electronics and communication Engineering
Name of Polytechnic: Name of College: G L Bajaj Institute of Technology and Management
Tel. No.: Tel. No.: 7835005112
Email Id.: Email Id.: director@glbitm.org
Board: University: AKTUĀ 
Year of Joining:
Year of Joining: 2016
Year of Passing: Percentage: Year of Passing: 2020 Percentage: 70
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 ? Travel, Volunteering, Exercise, sports like volleyball, Badminton.
What are your strengths ? Discipline, Dedication, Respectfulness, Patience
What are your weaknesses ? Humor, Being too Honest
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________

 
Print Summary and Application Form