VMI/FF-24B
16/04/2012
Rev. No.0 Iss. No 1
BRACTs
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:- info@vmipune.com
ADMISSION FORM
B.TECH. MARINE ENGINEERING (4 YEARS)
PERSONAL DETAILS:
APPLICATION NO.
1. Name of the candidatein BLOCK LETTERS.
.
Affix recent
passport size
photograph here
(Taken within
six months)
(As per HigherSecondarySchool or Equivalent Certificate)
2. Nationality:
4. Sex:
3.Religion:
Male
Female
6. (a) Date of Birth (in figures): Date
(b) Age:
Yrs
5. Marital Status:
Single
Month
Married
Year
st
Months (The applicants should be lesser in age than 25 years on 1 of August 2014)
(c) Place of Birth:
Village/Town/City. Dist
1.Name of Father / Guardian:
2. Occupation:
3. Permanent Address:
Pin Code:
State:
4. Present Address:
State:
5. Contact for communication:
a) Residence (R):
c) Mobile No:
Pin Code:
State:
b) Office (O):
c) E-mail ID:
8. Detail of Demand Draft:- Amount :Rs.1500/- D.D. No.
issuing bank & branch
2IMU™
SHANTI CONSULTANCY
Date:-
_
ACADEMIC RECORD:
th
10.10
(X) /SSC/EquivalentExam.
Year of
passing
th
11.12
State
Board
Marks Obtained in English Subject
Maximum marks
Marks obtained
(%)
(XII) /Higher Secondary or Equivalent Exam.(Science stream)
(a) Name of School / College with complete postal address,fromwhere the applicant has
th
passed /appeared in the 12 /HigherSecondary/ Equivalent Examination
Pin Code
State:
th
(b) State whether the applicant has passedthe qualifyingexamination(12 )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
State
Board /
University
Exam. Seat
Year of
No./ Roll No
passing
th
12 (XII) /HigherSecondaryor
Equivalent (Science stream)
(d) Marks of 12
th.
/Qualifying Examination, if passed. (Aggregate …………….. %)
Subjects
Maximum Marks
Marks Secured
Percentage
Physics
%
Chemistry
%
%
Mathematics
CumulativePhysics,
Chemistry & Mathematics Percentage:
%
English
%
------------------------------------------------------------------------------------------------------------------------------------------------
-
12.Extra CurricularActivities (Tick
Sports
Games
in appropriate choice)
N.C.C
Social service
13.How do you intend to meet the expenses of this course? (Tick
Own Resources
Relative Resources
Anyothers
in appropriate choice)
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
passport size
photograph here
(Taken within six
months)
To be filled in by the candidate
Name in BLOCK LETTERS:
Father’s Name:
Address:
PIN Code:_
District:_
State:
(Signature of the Applicant)
Admission In charge
CANDIDATE COPY
BRACTs
VISHWAKARMAMARITIMEINSTITUTE
Sr. No. 2, Kondhwa Budruk, Pune – 411 048
Tobe filledin byoffice
APPLICATION NUMBER:
Affix recent
passport size
photograph here
(Taken within six
months)
To befilled inbythe candidate
Name in BLOCK LETTERS:
Father’s Name:
Address:
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
Admission Round
1
At the time of
Joiningthe Institute
th
10 Marksheet
th
10 Passingout/Board Certificate
2
3
th
12 Marksheet
4
TransferCertificate
5
AgeCertificate
6
MigrationCertificate
7
PCM: MaximumMarks
8.
Ageason1 August 2014:
MarksObtained:
st
Dateof Birth:
Years
Date
Percentage
%
_ Months
Month
Year
Remark:
Name &Signatureof theVerifyingOfficer
ADMISSIONAUTHORITY
The Candidate has been found physically Fit / Unfit by a doctor approved by the Directorate
st
General of Shipping during his admission process and admitted to the 1 year of B.Tech. Marine
st
Engineering/ B.Sc. Nautical ScienceDegreecourseofourinstituteinthe year1 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. )
st
6 Your age as on 1 Aug.2015 is below25 years.
Your signature at all appropriate places
7 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 vmisponsorship@gmail.com
& Get VMI Sponsorship Test Preparation Support.
For offline Application : E-Mail scan of filled application & Mail it to
vmisponsorship@gmail.com
For Online Application: E-Mail Payment Receipt Confirmation to
vmisponsorship@gmail.com
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