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


Dossier ID: ETO2190327
Full Name (as per Passport) : shabana
Date of Birth (DD/MM/YY): 17 Oct 1991 Nationality: Vv
Gender (M/F): Female Marital Status (Single/Married): Single
Passport No.: Date of Expiry:
Place of Issue: Personal Identification Mark: jj

(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.: l
Street /Lane: l
Village / Post Office / Tehsil: l
City / District: l
State: Kerala
PIN: 410507
Telephone No. with STD code: Mobile: 9922680874

Academic Record -

Class X: - Class XII: -
Year of Passing: 2012 Year of Passing: 2015
Board: JMI Board: Maharashtra
English %: 4 English %: 40
Aggregate Percentage: 4 Aggregate Percentage: 40
Details of Marks Secured in (10+2) Examination -

Physics 100 80 80
Chemistry 100 80 80
Mathematics 100 80 80
English 100 80 80
Physics, Chemistry & Mathematics combined Percentage: 80


Diploma Specialization: Electrical Engineering Degree Specialization: Electrical and Electronics Engineering
Name of Polytechnic: mm Name of College: j
Tel. No.: 999999999 Tel. No.: 9922680874
Email Id.: 4@g.c Email Id.: 4@g.c
Board: 4 University: n 
Year of Joining: 2017
Year of Joining: 2017
Year of Passing: 2020 Percentage: 00 Year of Passing: 2021 Percentage: 00
Medium of Instruction: n Medium of Instruction: n

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 ? n
What are your strengths ? n
What are your weaknesses ? n

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

Signature of Candidate




Date ________________