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: DEG2195824
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Harsh Kumar Gautam
Mother's Name: Sanju Devi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 12 Aug 2003 Nationality: Indian
Place of Birth: JEHANABAD Personal Identification Mark: Cut mark below the nose
Blood Group: B +  
Date of Birth (DD/MM/YY): 12 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: House Number 62 NEWARI JEHANABAD
State: Bihar Country: India
Pin: 804425 City/District: JEHANABAD
Mobile no: 8409589008 Telephone No. with STD code: 06114
Aadhar Card No:207307637660 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Pankaj Kumar Gautam Relationship with candidate: Father
Parents Date of Birth: 04 Jan 1975 Parent's/Guardian's Occupation/Designation: Farmer
Office Address:
Address: House Number 62 NEWARI JEHANABAD
Country: India State: Bihar
City/District: JEHANABAD Pin: 804425
Tel: 06114 Mobile no.: 9835140599
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: DAV PUBLIC SCHOOL School: Shivam convent
City: Patna City: Patna
English %: 76 Board Roll No./Seat No.: 22654183
Aggregate Percentage: 69 School/College Code: 65414
  Address of School/College: Bypass Road, E Ashok Nagar Rd, Kankarbagh
  Centre code:
  Pin: 800020
  Contact Nos: 9431016845
  Aggregate Percentage: 76
Details of Marks Secured in (10+2) Examination -

Physics 100 76 76
Chemistry 100 74 74
Mathematics 100 58 58
Physics, Chemistry & Mathematics combined Percentage: 69.33
English 100 74 74
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: Revision of the portions for TMISAT
Why do you think your degree in Marine Engeneering/Nautical Science is good option for you?: Because I am interested
Why do you wish to join TMI?: Because it is one of the topmost colleges among INDIA
What are your hobbies?: Playing cricket
What are your strengths?: Patience and tolerance
What are your weaknesses?: Fearless nature.
How do you intend to meet the expenses of this program?: Bank Loan
Review you documents:
Your passport not uploaded Class X marksheet Leaving / Transfer Certificate / Birth Certificate Class XII admit card Class XII marksheet

I hereby declare that all the statements made above are true and correct.

Signature of Candidate



Date ________________