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: ETO2167676 Name: Surya Prakash Chandra Yadav
  Address: N 2/268 Tadia
Telephone No.: Mobile no: 9087738182
E-mail: impemail007@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 1212.73 (Includes Convenience fee of ₹ 12.73 ) DD Number: -
Issuing Bank: - Transaction Id: 402176431
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID ETO2167676 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: ETO2167676
 
Full Name (as per Passport) : Surya Prakash Chandra Yadav
Date of Birth (DD/MM/YY): 19 Sep 1995 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: Date of Expiry:
Place of Issue: Personal Identification Mark: Back spot on left waist

(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.: N 2/268
Street /Lane: Tadia
Village / Post Office / Tehsil: Sunderpur
City / District: Varanasi
State: Uttar Pradesh
PIN: 221005
Telephone No. with STD code: Mobile: 9087738182
E-mail: impemail007@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2011 Year of Passing: 2015
Board: CBSE Board: CBSE
English %: 85 English %: 73
Aggregate Percentage: 83 Aggregate Percentage: 74
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 74 74
Chemistry 100 81 81
Mathematics 100 54 54
English 100 73 73
Physics, Chemistry & Mathematics combined Percentage: 69.67
   
   

Diploma:

Graduation:
Diploma Specialization: Degree Specialization: Electrical and Electronics Engineering
Name of Polytechnic: Name of College: SRM Institute of Science And Technology
Tel. No.: Tel. No.: 914427455510
Email Id.: Email Id.: infodesk@srmist.edu.in
Board: University: SRM University 
Year of Joining:
Year of Joining: 2016
Year of Passing: Percentage: Year of Passing: 2020 Percentage: 74
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 ? Swimming, Cooking
What are your strengths ? Expeditious,Punctual,Team worker
What are your weaknesses ? Focus too much on details, Trouble saying No
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________

 
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