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VMI/FF-24B
BRACTs 16/04/2012
Rev. No.0 Iss. No 1
VISHWAKARMAMARITIMEINSTITUTE
Sr. No. 2, Kondhwa Budruk, Pune – 411 048 *Approved byDirectorate General of Shipping, Ministryof Shipping, Govt. ofIndia &
affiliated to Yashwantrao Chavan Maharashtra Open University(YCMOU), Nashik,a
State Own University
Website: - www.vmipune.com E-mail:- [email protected]
ADMISSION FORM
B.TECH. MARINE ENGINEERING (4 YEARS)
PERSONAL DETAILS:
1. Name of the candidatein BLOCK LETTERS.
(As per HigherSecondarySchool or Equivalent Certificate)
2. Nationality: 3.Religion:
4. Sex: Male Female 5. Marital Status: Single Married
6. (a) Date of Birth (in figures): Date
Month
Year
APPLICATION NO.
.
Affix recent
passport size
photograph here
(Taken within
six months)
(b) Age: Yrs Months (The applicants should be lesser in age than 25 years on 1st
of August 2014)
(c) Place of Birth: Village/Town/City. Dist State:
1.Name of Father / Guardian: 2. Occupation: _
3. Permanent Address: 4. Present Address:
Pin Code: State: Pin Code: State:
5. Contact for communication:
a) Residence (R): b) Office (O):
c) Mobile No: c) E-mail ID:
8. Detail of Demand Draft:- Amount :Rs.1500/- D.D. No. Date:-
issuing bank & branch
2IMU™
SHANTI CONSULTANCY
ACADEMIC RECORD:
10.10th
(X) /SSC/EquivalentExam.
Year of Board State Marks Obtained in English Subject
passing
Maximum marks Marks obtained (%)
11.12th
(XII) /Higher Secondary or Equivalent Exam.(Science stream)
(a) Name of School / College with complete postal address,fromwhere the applicant has
passed /appeared in the 12th
/HigherSecondary/ Equivalent Examination Pin Code State:
(b) State whether the applicant has passedthe qualifyingexamination(12th
)or appearingthis year
and the result is awaited? (Strike out whichever is not applicable)
Passed Appeared but resultawaited Appearingfor improvement
(c) Details of QualifyingExaminations:
Name of Examination Board / State Exam. Seat Year of
University No./ Roll No passing
12th
(XII) /HigherSecondaryor
Equivalent (Science stream)
(d) Marks of 12th.
/Qualifying Examination, if passed. (Aggregate …………….. %)
Subjects Maximum Marks Marks Secured Percentage
Physics %
Chemistry %
Mathematics %
CumulativePhysics, Chemistry & Mathematics Percentage: %
English
%
------------------------------------------------------------------------------------------------------------------------------------------------
-
12.Extra CurricularActivities (Tick in appropriate choice)
Sports Games N.C.C Social service Anyothers
13.How do you intend to meet the expenses of this course? (Tick in appropriate choice)
Own Resources Relative Resources Bank Loan Others
14.Declaration by the applicant:
I solemnly declare that all the particulars stated in this application are true to the best of my
knowledge and belief. In the event of my being found ineligible even at a later date, I understand that
my admission will be cancelled.
Signature of Applicant (Mr/Mrs……………………………….....................)
Name & Signature of Father/ Guardian
Place: Date: 2
EXAMINATION CENTRE COPY
BRACTs
VISHWAKARMAMARITIMEINSTITUTE Sr. No. 2, Kondhwa Budruk, Pune – 411 048
Tobe filled in byo ffice
APPLICATION NUMBER:
Affix recent
To be filled in by the candidate
passport size
Name in BLOCK LETTERS: photograph here
Father’s Name:
(Taken within six
Address:
months)
PIN Code:_ District:_ State:
Admission In charge
(Signature of the Applicant)
CANDIDATE COPY
BRACTs
VISHWAKARMAMARITIMEINSTITUTE Sr. No. 2, Kondhwa Budruk, Pune – 411 048
Tobe filledin byoffice
APPLICATION NUMBER:
Affix recent
To befilled inbythe candidate
passport size
Name in BLOCK LETTERS: photograph here
Father’s Name:
(Taken within six
Address:
months)
PIN Code:_ District:_ State:
(Signature of the Applicant) Admission In charge 3
OFFICE COPY
VERIFICATION OFORIGINAL DOCUMENTS
Sr.No Documents Status
At the time of At the time of Admission Round Joiningthe Institute
1 10th
Marksheet
2 10th
Passingout/Board Certificate 3 12
th Marksheet
4 TransferCertificate
5 AgeCertificate
6 MigrationCertificate
7 PCM: MaximumMarks MarksObtained: Percentage %
8. Ageason1st
August 2014: Years _ Months
Dateof Birth: Date
Month
Year
Remark:
Name &Signatureof theVerifyingOfficer
ADMISSIONAUTHORITY
The Candidate has been found physically Fit / Unfit by a doctor approved by the Directorate
General of Shipping during his admission process and admitted to the 1st
year of B.Tech. Marine
Engineering/ B.Sc. Nautical ScienceDegreecourseofourinstituteinthe year1st
August, 20__ AdmissionIn charge Director
CHECKLIST FOR CANDIDATES:
Beforesubmitting yourApplication Formpleaseensuresfollowingpoints: Please Tick [ ]
1 Name writtenat all places in the form should be identical
2 Your photograph on page no.1 hasbeen signed by you & other two should be pasted on page no.3
3 Admission form signed by your father / guardian.
4 Application form must be submitted in an envelope super-scribed with the words in accordance with
Course applied for. "Application for admission to B.Tech Marine Engineering"
5 Demand Draft of Rs.1500/- in favor of “Vishwakarma Maritime Institute”payableat
Pune.(Write your name and contact number on back side of D.D. )
6 Your age as on 1st
Aug.2015 is below25 years.
7
Your signature at all appropriate places
Read Instruction and complete application form in all respects.
INSTRUCTION FOR SPONSORSHIP
APPLICATION
Complete all the available details required and attached the DEMAND DRAFT of Rs 1500 (Application Processing Fee) drawn in favor of “Vishwakarma Maritime Institute” Payable at Pune.
Get VMI Sponsorship Test Preparation support – By Shanti Consultancy Absolutely Free , Just mail your filled application form to [email protected] & Get VMI Sponsorship Test Preparation Support.
For offline Application : E-Mail scan of filled application & Mail it to [email protected] For Online Application: E-Mail Payment Receipt Confirmation to [email protected]
Also For offline Application, Hard copy of filled application along with Demand Draft should be sent Via fastest Courier to :
Mr. Mahesh More ( Admission In charge) VISHWAKARMA MARITIME INSTITUTE SURVEY NO.2, LAXMI NAGAR, KONDHWA ( BUDRUK), PUNE- 411048 Help-Line- 09304612791
