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.Tech. Marine Engineering
Dossier ID: DEG2170042
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: SHIVANSH SAXENA
Mother's Name: EKTA SAXENA
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 29 Oct 2002 Nationality: INDIAN
Place of Birth: Lucknow Personal Identification Mark: Mole on left elbow
Blood Group: O +  
Date of Birth (DD/MM/YY): 29 Oct 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: 19/3, Lajpat Nagar Chowk P.O. Chowk
State: Uttar Pradesh Country: India
Pin: 226003 City/District: Lucknow
Mobile no: 7905639419 Telephone No. with STD code:
Aadhar Card No:628529668697 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: SHIVANKAR SAXENA Relationship with candidate: FATHER
Parents Date of Birth: 06 Mar 1974 Parent's/Guardian's Occupation/Designation: Service
Office Address:
Address: 19/3, Lajpat Nagar Chowk P.O. Chowk
Country: India State: Uttar Pradesh
City/District: Lucknow Pin: 226003
Tel: Mobile no.: 8400600102
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
City: Lucknow City: Lucknow
English %: 82 Board Roll No./Seat No.:
Aggregate Percentage: 80 School/College Code:
  Address of School/College: HAZRATGANJ LUCKNOW
  Centre code:
  Pin: 226001
  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 ?: entrance exam preparation and physical activities
Why do you think your degree in Marine Engeneering/Nautical Science is good option for you?: good career prospects
Why do you wish to join TMI?: reputed institution in maritime studies
What are your hobbies?: playing guitar and athletics
What are your strengths?: goal oriented , hardworking , family support
What are your weaknesses?: frequently distracted
How do you intend to meet the expenses of this program?: Own Resources,Bank Loan
Review you documents:
Your passport not uploaded 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 ________________