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: ETO2197075 Name: Sairaj Mohan Kudalkar
  Address: 2/273 G DONGARPUR NAIKAWADDO
Telephone No.: Mobile no: 9021887560
E-mail: sairajkudalkar026@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: 13883939997
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID ETO2197075 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: ETO2197075
 
Full Name (as per Passport) : Sairaj Mohan Kudalkar
Date of Birth (DD/MM/YY): 26 Jul 1998 Nationality: INDIAN
Gender (M/F): Male Marital Status (Single/Married): Single
Passport No.: NA Date of Expiry:
Place of Issue: NA Personal Identification Mark: NA

(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.: 2/273 G
Street /Lane: DONGARPUR NAIKAWADDO
Village / Post Office / Tehsil: CALANGUTE
City / District: NORTH
State: Goa
PIN: 403516
Telephone No. with STD code: Mobile: 9021887560
E-mail: sairajkudalkar026@gmail.com  
 

Academic Record -

 
Class X: - Class XII: -
Year of Passing: 2014 Year of Passing:
Board: Goa Board:
English %: 62 English %:
Aggregate Percentage: 59 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 and Electronics Engineering
Name of Polytechnic: Government Polytechnic Panaji Name of College: Jain college of engineering
Tel. No.: 08322225973 Tel. No.: 08312411192
Email Id.: dgpp@goal.dot.net.in Email Id.: principal@jainbgm.in
Board: Board of techniacl education University: visvesvaraya technological university 
Year of Joining: 2014
Year of Joining: 2018
Year of Passing: 2017 Percentage: 64 Year of Passing: 2021 Percentage: 67
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 -

Work Experience, if any -

Name of the Firm Designation From To
       
       
       
 
What are your hobbies ? outdoor activities,team or individual sport,exercising and healthcare
What are your strengths ? teamwork,multitasking,leadership skills
What are your weaknesses ? focusing on small details
 
 
Declaration

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

Signature of Candidate

 

___________________

 

Date ________________

 
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