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: ETO2190990
 
Full Name (as per Passport) : ayush verma
Date of Birth (DD/MM/YY): 13 Mar 1996 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: Z5009484 Date of Expiry:
Place of Issue: dehradun Personal Identification Mark: two moles in right cheek

(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.: bhumia vihar A3
Street /Lane: gas godam road, kusumkhera
Village / Post Office / Tehsil: haldwani
City / District: haldwani
State: Uttaranchal
PIN: 263139
Telephone No. with STD code: Mobile: 9456340034
E-mail: vermaayush9613@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2012 Year of Passing: 2014
Board: ISCE Board: ISCE
English %: 66 English %: 78
Aggregate Percentage: 80 Aggregate Percentage: 80
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 74 74
Chemistry 100 74 74
Mathematics 100 80 80
English 100 78 78
Physics, Chemistry & Mathematics combined Percentage: 76
   
   

Diploma:

Graduation:
Diploma Specialization: Degree Specialization: Electrical and Electronics Engineering
Name of Polytechnic: Name of College: National Institute of Technology NITUttarakhand
Tel. No.: Tel. No.: 01346257422
Email Id.: Email Id.: ar.academic@nituk.ac.in
Board: University: NIT 
Year of Joining:
Year of Joining: 2015
Year of Passing: Percentage: Year of Passing: 2019 Percentage: 62
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 ? football reading novels
What are your strengths ? patience determination ethusiasm innovative optimstic
What are your weaknesses ? analytical idealistic
 
 
Declaration

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

Signature of Candidate

 

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Date ________________