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 info@vmipune.com, 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

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.

10th 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

Applicants Signature

drawn in

Date

APPLICATION RECEIVED ON
: INTERVIEW ED ON

RESULTS OF INTERVIEW

MEDICAL EXAMINATION

SELECTED TO JOIN

PASSED
PASSED
YES

FAILED
FAILED
NO

DIRECTOR