VISHWAKARMA MARITIME INSTITUTE
(INDoS No- 87)
CRISIL Grade - Very Good & ISO 9001:2008 Certified
Application
Number
VMI/FF-24
01/02/2010
Rev.No.0 Iss.No.1
Sr. No.2,Kondhwa Bk.,Pune411048. Tel.91-20-64785715/16 Fax:91-20-26932700
E-mail [email protected], Web site - www.vmipune.com.
ADMISSION FORM
GRADUATE MARINE ENGINEERING (1 YR)
Affix recent
passport size
photograph
here (Taken
within six
months)
PLEASE CO MPLETE IN BLOCK LETTERS
Personal Details:
FULL NAM E (in capitals): (As given in the rec ords of Board / University)
(Last Name)
(First Name)
(Middle Name)
(Last Name)
Occupation (in full detail):
(First Name)
(Middle Name)
Father's Name:
Now stationed at:
Address for Correspondence:
Pin co de:
State:
Tel No. (W ith STD Code)
Email ID:
Address of next of kin or Guardian (with relationship to c ontact in cas e of emergenc y)
Pin code:
S tate:
Tel No. ( W ith STD Code):
Email ID:
Date of Birth
Nationality
Place of Birth
Passport No.
Place of Issue
Marital Status
Ref: SUMIT KUMAR
Sex
(if available)
Male / Female
Date of Issue
Date of Expiry
Height
cms Weight
Kgs
Qualifications :
Name of School -where you completed X Std.:Name of School/College -where you completed XII Std:Name of College and Board / University from where you obtained your Degree course
Month & Year of passing in B.E. Mech.:
Subject
Marks
X Std
XII Std
Percentage Obtained
X Std
XII Std
ENGLISH
Final Year
Aggregate
Final Year B.E. Mech/Naval Arch.
Engineering college AICTE approval / UGC recognisation No.
Encl. attested photocopies of documents
1.
th
10
Mark Sheet
5. Birth date Certificate
th
2.
10 Certificate
3.
12th Mark Sheet
7. Engineering Degree Cert.
4.
12th Certificate
8. Passport copy( if available)
6. Engineering Mark Sheets( all semester)
Career Adviser (If any) :
Source of your information about VMI:
Further Information:
Please give any further appropriate information to support your application e.g. Achievements, Extra
Curricular Activities, hobbies, special interests, etc.
I hereby declare that I hav e read and understood the conditions of eligibility for the course to which I
seek admission. I fulfill the minimum eligibility criteria and I have provided necessary information in this
regard. In the ev ent of any information being found incorrect or misleading my candidature shall be
liable to cancellation at any time and I shall not be entitled to refund of any fee paid by me to the
academy. The original certificates will be produced at the time of Interview.
Registration Fee of Rs.1500/- by Cash/Demand Draft No.
favour of Vishwakarma Maritime Institute Payable at Pune
dated
drawn in
Date
Applicants Signature
APPLICATION RECEIVED ON
: INTERVIEW ED ON
RESULTS OF INTERVIEW
MEDICAL EXAMINATION
SELECTED TO JOIN
Ref: SUMIT KUMAR
PASSED
PASSED
YES
FAILED
FAILED
NO
DIRECTOR