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: ETO2167670
 
Full Name (as per Passport) : POTHULA CHAITANYA KUMAR
Date of Birth (DD/MM/YY): 27 Dec 1998 Nationality: INDIAN
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: Date of Expiry:
Place of Issue: Personal Identification Mark: A MOLE ON LEFT SIDE OF THE NOSE

(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.: 24-409,2ND FLOOR
Street /Lane: LAKSHMI NAGAR CLONY,NEAR LAKSHMI KALA THEATRE,LOTHUKUNTA
Village / Post Office / Tehsil: TRIMULGHERRY
City / District: HYDERABAD
State: Other
PIN: 500015
Telephone No. with STD code: Mobile: 7032962063
E-mail: chaitanyakumar626@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2014 Year of Passing:
Board: Andhra Pradesh Board:
English %: 80 English %:
Aggregate Percentage: 70 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: Electronics and communication Engineering
Name of Polytechnic: Name of College: ST MARTINS ENGINEERING COLLEGE
Tel. No.: Tel. No.: 9000444576
Email Id.: Email Id.: verify@smec.ac.in
Board: University: JAWAHARLALA NEHRU TECHNOLOGICAL UNIVERSITY 
Year of Joining:
Year of Joining: 2016
Year of Passing: Percentage: Year of Passing: 2020 Percentage: 60
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 ? PLAYING CRICKET,SURFING INTERNET
What are your strengths ? SELF CONTROL AND ADAPTABILITY
What are your weaknesses ? TIME MANAGEMENT
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________