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.Sc. Nautical Science Course: Second Choice B.Sc. Nautical Science
Dossier ID: DEG2168623
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Kuzhivila Jacob John
Mother's Name: Ammini John
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 21 Dec 2002 Nationality: Indian
Place of Birth: Punalur Personal Identification Mark: A small black mole below nose
Blood Group: A +  
Date of Birth (DD/MM/YY): 21 Dec 2002 Nationality: Indian
Gender (M/F): Male Marital Status (Single/Married): Single
Full Name (as per Passport) : Kuzhivila Jacob John Passport No.: U8910806
Date of Expiry: 05 Apr 2031 Place of Issue: Surat
(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: Flat no 204, Safari Complex Opp Navin Fluorine, Bhesthan, Surat.
State: Gujarat Country: India
Pin: 390523 City/District: Surat
Mobile no: 9408487861 Telephone No. with STD code:
Aadhar Card No:735607502716 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: John Unnunni Relationship with candidate: Father
Parents Date of Birth: 20 May 1969 Parent's/Guardian's Occupation/Designation: Fabrication Works
Office Address:
Address: Laxmi Engineering Company Plot No. 258/8-9, Near Shiv Vijay Processors, G.I.D.C, Pandesara, Surat.
Country: India State: Gujarat
City/District: Surat Pin: 394221
Tel: 09825795282 Mobile no.: 9825795282
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Gujarat Board: Gujarat
School: Mary Matha Public School School: Mary Matha Public School
City: Surat City: Surat
English %: 84 Board Roll No./Seat No.:
Aggregate Percentage: 87 School/College Code:
  Address of School/College: 1120, post box, Batliboi Company, Near, Society, Bhedwad, Pramukh Park, Udhna, Surat, Gujarat
  Centre code:
  Pin: 394220
  Contact Nos:
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics 150
Chemistry 150
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 ?: I would like to spend my time in making myself physically fit and will read books to upgrade my knowledge level
Why do you think your degree in Marine Engeneering/Nautical Science is good option for you?: I think a degree in nautical science is a good option for me because I want to explore through the oceanic world and of course ships are my favourite.
Why do you wish to join TMI?: Tolani is the best maritime institute in India, with a wide aspect of knowledge, training and placement percentage. Its a half way to success.
What are your hobbies?: Reading, Dancing and playing quizes
What are your strengths?: Memory Power and good in studies
What are your weaknesses?: Not good in sports
How do you intend to meet the expenses of this program?: Own Resources
Review you documents:
Your passport Class X marksheet Leaving / Transfer Certificate / Birth Certificate 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 ________________