Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail: admissions@tmi.tolani.edu, Web: www.tolani.edu
Electro-Technical Officers Course
(Pre-sea Training & Certification for Merchant Ships)

APPLICATION FOR ADMISSION - October 2021


Application Summary
 
Dossier ID: ETO2167672 Name: POTHULA CHAITANYA KUMAR
  Address: 24-409,2ND FLOOR LAKSHMI NAGAR CLONY,NEAR LAKSHMI KALA THEATRE,LOTHUKUNTA
Telephone No.: Mobile no: 7032962063
E-mail: palekhya626@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 1282.6 (Includes Convenience fee of ₹ 82.6 ) DD Number: -
Issuing Bank: - Transaction Id: 402124402
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID ETO2167672 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 keep a copy of the form for your reference for communicating with the Institute.
Institute will communicate with you once the form is submitted and online payment is done successfully. Please keep all your academic certificates & Annex-I ready with you.

     
     

Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail: admissions@tmi.tolani.edu, Web: www.tolani.edu
Electro-Technical Officers Course
(Pre-sea Training & Certification for Merchant Ships)

APPLICATION FOR ADMISSION - October 2021

Dossier ID: ETO2167672
 
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: palekhya626@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: JAWAHARLAL 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 ________________

 
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