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 2022

Dossier ID: ETO2190894
 
Full Name (as per Passport) : Shivam Radheyshyam Khare
Date of Birth (DD/MM/YY): 19 May 1995 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: Applied Date of Expiry:
Place of Issue: Mumbai Personal Identification Mark: Mole on Right Hand Wrist

(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.: 1205,Srishti Elegance,Sonapur Lane,LBS Marg, Bhandup West
Street /Lane: Sonapur Lane
Village / Post Office / Tehsil: Bhandup West
City / District: Mumbai
State: Maharashtra
PIN: 400078
Telephone No. with STD code: Mobile: 9137622819
E-mail: shivam.khare1995@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2010 Year of Passing:
Board: Maharashtra Board:
English %: 81 English %:
Aggregate Percentage: 91 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: Electronics Engineering Degree Specialization: Electronics Engineering
Name of Polytechnic: K J Somaiya Polytechnic Name of College: KJSIEIT
Tel. No.: 02221023443 Tel. No.: 02224061408
Email Id.: kavita.kadam@somaiya.edu Email Id.: kavita.kadam@somaiya.edu
Board: Autonomous University: Mumbai University 
Year of Joining: 2010
Year of Joining: 2015
Year of Passing: 2013 Percentage: 79 Year of Passing: 2019 Percentage: 51
Medium of Instruction: English Medium of Instruction: English

Note: Diploma/Degree courses must be recognised by any State or Central Government or the AICTE.

Other Qualification, if any -
Practical Training in Industrial Automation.

Work Experience, if any -

Name of the Firm Designation From To
Valmet Automation Project Engineer    
       
       
 
What are your hobbies ? Football,Music
What are your strengths ? Optimist,Focused,Determined
What are your weaknesses ? Public speaking
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________