Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail:, Web:
Marine Engineering / Nautical Science Degree Programmes
(New Admission B.Tech. Marine Engineering / B.Sc. Nautical Science )


Course: First Choice B.Tech. Marine Engineering Course: Second Choice B.Sc. Nautical Science
Dossier ID:
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Roushan Kumar
Mother's Name: Ritu Devi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 07 Nov 2002 Nationality: INDIAN
Place of Birth: Patna Personal Identification Mark: Mole on face
Blood Group: A +  
Date of Birth (DD/MM/YY): 07 Nov 2002 Nationality: INDIAN
Gender (M/F): Male Marital Status (Single/Married): Single
Full Name (as per Passport) : Passport No.:
Date of Expiry: Place of Issue:
(Note: If you do not have passport, you may apply for it as early as possible as passport is required for obtaining Seaman’s Discharge Certificate, mandatory for boarding a ship.)
Address for Communication: Vill- Lodipur Dinapur cum khagaul Patna, Bihar 801503 Vill-Lodipur Dinapur cum khagaul
State: Bihar Country: India
Pin: 801503 City/District: Patna
Mobile no: 7654729390 Telephone No. with STD code:
Aadhar Card No:415446677337 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: BRIJNANDAN SINGH Relationship with candidate: Father
Parents Date of Birth: 15 Oct 1979 Parent's/Guardian's Occupation/Designation: Business man
Office Address:
Address: Vill- Lodipur Dinapur cum khagaul, Patna Vill-Lodipur Dinapur cum khagaul Patna, Bihar
Country: India State: Bihar
City/District: Patna Pin: 801503
Tel: Mobile no.: 8434792306
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2021 (Appearing for improvement)
Board: CBSE Board: CBSE
City: Patna City: Patna
English %: 67 Board Roll No./Seat No.:
Aggregate Percentage: 50 School/College Code:
  Address of School/College: NIRALA NAGAR DIGHA PATNA BIHAR
  Centre code:
  Pin: 800012
  Contact Nos:
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics 100
Chemistry 100
Mathematics 100
Physics, Chemistry & Mathematics combined Percentage:
English 100
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?:
Why do you think your degree in Marine Engeneering/Nautical Science is good option for you?:
Why do you wish to join TMI?:
What are your hobbies?:
What are your strengths?:
What are your weaknesses?:
How do you intend to meet the expenses of this program?: 
Review you documents:
Your passport not uploaded Class X marksheet not uploaded Leaving / Transfer Certificate / Birth Certificate not uploaded Class XII admit card not uploaded Class XII marksheet not uploaded

I hereby declare that all the statements made above are true and correct.

Signature of Candidate



Date ________________

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