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: DEG2189777
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Chinmaya B N
Mother's Name: Shailaja
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 23 Jan 2004 Nationality: Indian
Place of Birth: Davanagere Personal Identification Mark: Stitches on forehead
Blood Group: O +  
Date of Birth (DD/MM/YY): 23 Jan 2004 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: 299,18th cross, 21 main 2nd stage , JP Nagar , Mysore
State: Karnataka Country: India
Pin: 570008 City/District: Mysuru
Mobile no: 9900505710 Telephone No. with STD code:
Aadhar Card No: E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Nagaraj BA Relationship with candidate: Father
Parents Date of Birth: 26 Jul 1969 Parent's/Guardian's Occupation/Designation: Employee
Office Address:
Address: 299,18th cross 21 main JP nagar
Country: India State: Karnataka
City/District: Mysuru Pin: 570008
Tel: 09900505710 Mobile no.: 9686616018
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: Karnataka
School: Maharishi Public School School: Vijaya Vittala Pu college
City: Mysuru City: Mysuru
English %: 88 Board Roll No./Seat No.:
Aggregate Percentage: 85 School/College Code:
  Address of School/College: Vijaya Vittala composite Pu college, Saraswatipuram,Mysuru
  Centre code:
  Pin: 570009
  Contact Nos: 09900505710
  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:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
10/2019 Volleyball State Participant
How do you intend spending your time after completing class XII Final exams and before joining college ?: By getting prepared for competitive exams
Why do you think your degree in Marine Engeneering/Nautical Science is good option for you?: I have interest in these courses
Why do you wish to join TMI?: A good college
What are your hobbies?: Playing sports and practicing piano
What are your strengths?: My confidence
What are your weaknesses?: I can do only one work at a time
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 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 ________________