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


Application Summary
 
Dossier ID: ETO2191129 Name: Ahmed Raza Khan
  Address: 56 Beck Bagan Row
Telephone No.: Mobile no: 9831055786
E-mail: khan.raza4@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 1200.00 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 13611904981
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID ETO2191129 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 2022

Dossier ID: ETO2191129
 
Full Name (as per Passport) : Ahmed Raza Khan
Date of Birth (DD/MM/YY): 25 Dec 1992 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: K0488461 Date of Expiry:
Place of Issue: Kolkata Personal Identification Mark: A mole on the ring finger of right 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.: 56
Street /Lane: Beck Bagan Row
Village / Post Office / Tehsil: Circus Avenue
City / District: Kolkata
State: West Bengal
PIN: 700017
Telephone No. with STD code: Mobile: 9831055786
E-mail: khan.raza4@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2009 Year of Passing: 2011
Board: ISCE Board: ISCE
English %: 86 English %: 83
Aggregate Percentage: 84 Aggregate Percentage: 83
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 66 66
Chemistry 100 83 83
Mathematics 100 83 83
English 100 83 83
Physics, Chemistry & Mathematics combined Percentage: 77.33
   
   

Diploma:

Graduation:
Diploma Specialization: Degree Specialization: Electronics and Telecommunication Engineering
Name of Polytechnic: Name of College: Budge Budge Institute of Technology
Tel. No.: Tel. No.: 8420123333
Email Id.: Email Id.: contact@bbit.edu.in
Board: University: West Bengal University Of Technology 
Year of Joining:
Year of Joining: 2011
Year of Passing: Percentage: Year of Passing: 2015 Percentage: 67
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 -
Diploma in Computer Application

Work Experience, if any -

Name of the Firm Designation From To
HCL Technologies Software Engineer    
       
       
 
What are your hobbies ? Currency collection, Swimming, Football
What are your strengths ? Problem solving
What are your weaknesses ? Laziness
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________

 
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