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:
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Shubham Regmi
Mother's Name: Anjana Regmi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 20 Aug 2003 Nationality: Indian
Place of Birth: RISHIKESH Personal Identification Mark: Black Mole behind left ear
Blood Group: AB +  
Date of Birth (DD/MM/YY): 20 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: GALI NO-7 WARD-6 Dr nawani clinic Hanuman Mandir neem Karoli Nagar Virbhadra ,Rishikesh
State: Uttaranchal Country: India
Pin: 249202 City/District: RISHIKESH
Mobile no: 8534063855 Telephone No. with STD code: 8534063855
Aadhar Card No:967181723492 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Karan Bahadur Regmi Relationship with candidate: Father
Parents Date of Birth: 20 Jun 1979 Parent's/Guardian's Occupation/Designation: Security supervisor
Office Address:
Address: AIIMS hospital Rishikesh
Country: India State: Uttaranchal
City/District: RISHIKESH Pin: 249202
Tel: 8534063855 Mobile no.: 9897303767
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: Year of Passing:
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School: School:
City: City:
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Details of Marks Secured in (10+2) Examination -

Physics, Chemistry & Mathematics combined Percentage:
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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