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: ETO2190851
 
Full Name (as per Passport) : rubait e khaiyyam ansari
Date of Birth (DD/MM/YY): 01 May 1993 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: Date of Expiry:
Place of Issue: Personal Identification Mark: operation mark in left hand

(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.: 87 TALBAGAN PARA BERHAMPORE,
Street /Lane: MURSHIDABAD
Village / Post Office / Tehsil: talbagan para
City / District: Murshidabad
State: West Bengal
PIN: 742101
Telephone No. with STD code: Mobile: 8388888018
E-mail: rubaitansari1993@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2008 Year of Passing:
Board: West Bengal Board:
English %: 55 English %:
Aggregate Percentage: 62 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: Electrical Engineering Degree Specialization: Electrical Engineering
Name of Polytechnic: RUBAIT E KHAIYYAM ANSARI Name of College: SILIGURI INSTITUTE OF TECHNILOGY
Tel. No.: 8388888018 Tel. No.: 8388888018
Email Id.: rubaitansari1993@gmail.com Email Id.: sit99@rediffmail.com
Board: WBTE University: w.b.u.t 
Year of Joining: 2008
Year of Joining: 2011
Year of Passing: 2011 Percentage: 73 Year of Passing: 2015 Percentage: 62
Medium of Instruction: english Medium of Instruction: englich

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 ? helping people,bike riding,
What are your strengths ? i can cope any situation
What are your weaknesses ? not rude
 
 
Declaration

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

Signature of Candidate

 

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Date ________________