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: ETO2167688
 
Full Name (as per Passport) : AYUSH CHAUBEY
Date of Birth (DD/MM/YY): 05 Mar 1999 Nationality: INDIAN
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: Date of Expiry:
Place of Issue: Personal Identification Mark: BLACK DOT MARK OR TIL MARK AT STOMACH

(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.: P.NO.19 KH.NO,442 SA ANANDESHWAR VIHAR COLONY
Street /Lane: SATRIKH ROAD
Village / Post Office / Tehsil: SARAI SHEIKH NANDPUR CHINHAT
City / District: LUCKNOW
State: Uttar Pradesh
PIN: 226028
Telephone No. with STD code: Mobile: 8738939959
E-mail: ayushchaubey09101997@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2014 Year of Passing: 2016
Board: CBSE Board: CBSE
English %: 95 English %: 80
Aggregate Percentage: 76 Aggregate Percentage: 72
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 76 76
Chemistry 100 64 64
Mathematics 100 66 66
English 100 80 80
Physics, Chemistry & Mathematics combined Percentage: 68.67
   
   

Diploma:

Graduation:
Diploma Specialization: Degree Specialization: Electrical Engineering
Name of Polytechnic: Name of College: BABU BANARSI DAS NORTHERN INDIA INSTITUTE OF TECHNOLOGY
Tel. No.: Tel. No.: 05223911048
Email Id.: Email Id.: director@bbdniit.ac.in
Board: University: DR.A.P.J.ABDUL KALAM TECHNICAL UNIVERSITY 
Year of Joining:
Year of Joining: 2016
Year of Passing: Percentage: Year of Passing: 2020 Percentage: 81
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 ? COOKING, RIDING
What are your strengths ? PEACE OF MIND , MY WORK
What are your weaknesses ? PUBLIC SPEAKING , BARGAINING
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________