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.Tech. Marine Engineering
Dossier ID:
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Raj gupta
Mother's Name: Madhuri gupta
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 28 Aug 2003 Nationality: Indian
Place of Birth: M.P Personal Identification Mark: Cut on mid of the nose
Blood Group: B -  
Date of Birth (DD/MM/YY): 28 Aug 2003 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: Acc colony sindri dhanbad, jharkhand G-17-C near little angle park Acc colony sindri dhanbad, jharkhand , -G-17-C near goal chakkar
State: Jharkhand Country: India
Pin: 828122 City/District: Sindri
Mobile no: 7541965828 Telephone No. with STD code: 6287726169
Aadhar Card No:280231260028 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Makhan lal gupta Relationship with candidate: Father
Parents Date of Birth: 20 Jul 1970 Parent's/Guardian's Occupation/Designation: Mechanical engineer
Office Address:
Address: Acc colony sindri , dhanbad , jharkhand , near little angle park Acc colony sindri , dhanbad , jharkhand , near goal chakkar
Country: India State: Jharkhand
City/District: Sindri Pin: 828122
Tel: Mobile no.: 6287726169
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: ISCE Board: CBSE
School: De Nobili School Sindri dhanbad School: Lions public school sindri
City: Sindri City: Simdri
English %: 70 Board Roll No./Seat No.:
Aggregate Percentage: 51 School/College Code:
  Address of School/College: Lions public school rangamati sindri dhanbad
  Centre code:
  Pin: 828122
  Contact Nos: 6287726169
  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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