BRACTs
Sr. No. 2, Kondhwa Budruk, Pune – 411 048
*Approved by Directorate General of Shipping, Ministry of Shipping, Govt. of India
& affiliated to Yashwantrao Chavan Maharashtra Open University(YCMOU),
Nashik,a State Own University
VMI/FF-24 B
1 6/04/2012
Rev. No.0 Iss. No 1
Website: www.vmipune.com
E-mail:info@vmipune.com
B.TECH. MARINE ENGINEERING (4 YEARS)
PERSONAL DETAILS:
1.
Name of the candidate in BLOCK LETTERS.
APPLICATION NO.
(As per Higher Secondary School or Equivalent Certificate)
2.
Nationality: 3.
Religion:
4.
Sex: Male Female 5.
Marital Status: Single Married
.
passport size photograph here
(Taken within six months)
6.
(a) Date of Birth (in figures) : Date
(b) Age: Yrs
Month Year
Months (The applicants should be lesser in age than 25 years on 1 st of August 20 14 )
(c) Place of Birth: Village/Town/City. Dist State:
7.
1.Name of Father / Guardian:
3. Permanent Address: 4. Present Address:
2. Occupation: _
Pin Code: State:
5. Contact for communication: a) Residence (R): c) Mobile No:
Pin Code: b) Office (O): c) E-mail ID:
State:
8. Detail of Demand Draft:Amount :Rs.1
5 00/- D.D. No.
issuing bank & branch
9.
Career Adviser (If any) :
Source of your information about VMI:
1
Da te:-

ACADEMIC RECORD:
10 . 10 th (X) /SSC/Equivalent Exam.
Year of passing
Board State Marks Obtained in English Subject
Maximum marks Marks obtained (%)
1 1 . 12 th (XII) /Higher Secondary or Equivalent Exam.(Science stream)
(a) Name of School / College with complete postal address, from where the applicant has passed / appeared in the 12 th /Higher Secondary / Equivalent Examination
Pin Code State:
(b) State whether the applicant has passed the qualifying examination (12 th ) or appearing this year and the result is awaited? (Strike out whichever is not applicable)
Passed Appeared but result awaited Appearing for improvement
(c) Details of Qualifying Examinations:
Name of Examination Board /
University
State Exam. Seat
No./ Roll No
Year of passing
12 th (XII) /Higher Secondary or
Equivalent (Science stream)
(d) Marks of 12 th.
/ Qualifying Examination, if passed. (Aggregate …………….. %)
Subjects Maximum Marks Marks Secured
Physics
Chemistry
Mathematics
Cumulative Physics, Chemistry & Mathematics Percentage:
Percentage
%
%
%
%
English
%
------------------------------------------------------------------------------------------------------------------------------------------------
-
1 2 .
Extra Curricular Activities (Tick in appropriate choice)
Sports Games N.C.C
1 3 .
How do you intend to meet the expenses of this course? (Tick
Own Resources Relative Resources
Social service Any others in appropriate choice)
Bank Loan Others
1 4 . 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……………………………… .....................)
Place:
Name & Signature of Father / Guardian
Date:
2

BRACTs
Sr. No. 2, Kondhwa Budruk, Pune – 411 048
To be filled in by office
APPLICATION NUMBER:
To be filled in by the candidate
Name in BLOCK LETTERS:
Father’s Name:
Address:
Affix recent passport size photograph here
(Taken within six months)
PIN Code:_ District:_ State:
( Signature of the Applicant) Admission In charge
BRACTs
Sr. No. 2, Kondhwa Budruk, Pune – 411 048
To be filled in by office
APPLICATION NUMBER:
To be filled in by the candidate
Name in BLOCK LETTERS:
Father’s Name:
Address:
Affix recent passport size photograph here
(Taken within six months)
PIN Code:_ District:_ State:
( Signature of the Applicant) Admission In charge
3

Sr.No
6
7
8.
1
2
3
4
5
Remark:
Date of Birth:
VERIFICATION OF ORIGINAL DOCUMENTS
Documents Status
At the time of
Admission Round
10 th
10 th
12 th
Mark sheet
Passing out /Board Certificate
Mark sheet
Transfer Certificate
Age Certificate
At the time of
Joining the Institute
Migration Certificate
PCM: Maximum Marks
Age as on 1 st
August 201 4 :
Marks Obtained:
Years _ Months
Percentage %
Date Month Year
Name & Signature of the Verifying Officer
ADMISSION AUTHORITY
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 1 st year of B.Tech. Marine
Engineering / B.Sc. Nautical Science Degree course of our institute in the year 1 st
August, 20 __
Admission In charge Director
Before submitting your Application Form please ensures following points:
1 Name written at all places in the form should be identical
Please Tick [  ]
2 Your photograph on page no.1 has been 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" Or
"Application for admission to B.Sc. Nautical Science"
5
6
Demand Draft of Rs.1
5 00/- in favour of “Vishwakarma Maritime Institute” payable at
Pune.( Write your name and contact number on back side of D.D. )
Your age as on 1 st
Aug.201
4 is below 25 years.
7 Your signature at all appropriate places