Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail: info@tmi.tolani.edu, Web: www.tolani.edu
(New Admission Diploma in Nautical Science 2020)


Application Summary: Diploma in Nautical Science
 
Dossier ID: DNS2049760 Name: Mohammed Ashik Rahman
  Address: Badriya house, Mudipu Azad Nagar Bantwal Taluk ,Mangalore-DK
Telephone No.: Mobile no: 7338213195
E-mail: m.ashiq7426422@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 304389949
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2049760 are true and correct.
Signature of Candidate Signature of Parent/Guardian
   
   

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Date ________________ Date ________________
 
Please quote your dossier id and full name for any future correspondence
Please keep a copy of the form for your reference for communicating with the Institute

Note: Please remember to login and fill in your 12th std PCM marks when they are published & IMUCET Application number in order to complete your application form.

Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail: info@tmi.tolani.edu, Web: www.tolani.edu
(New Admission Diploma in Nautical Science )

APPLICATION FOR ADMISSION - 2020

 
  Dossier ID: DNS2049760
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: Mohammed Ashik Rahman
Mother's Name: Aysha Sulthana
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 09 Feb 2000 Nationality: INDIAN
Place of Birth: Mangalore Personal Identification Mark: Acid Mark on left hand
Blood Group: B + Address for Communication: Badriya house, Mudipu Azad Nagar Bantwal Taluk ,Mangalore-DK
State: Karnataka Country: India
Pin: 574153 City/District: Dakshina Kannada
Mobile no: 7338213195 Telephone No. with STD code:
Aadhar Card No:298547729124 E-mail: m.ashiq7426422@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: Abdul Razak Relationship with candidate: Father
Parents Date of Birth: 13 Mar 1970 Parent's/Guardian's Occupation/Designation: Businessman
   
Office Address:
   
Address: Badriya house Mudipu
Country: India State: Karnataka
City/District: Dakshina Kannada Pin: 574153
Tel: Mobile no.: 8550055448
Fax: Email: assa67704@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2019
Board: CBSE Board: Karnataka
School: Kanachur Public School School: Yenepoya Pre-University college
City: Derlakatte City: Mangalore
English %: 93 Board Roll No./Seat No.: 200246
Aggregate Percentage: 93 School/College Code: SS295
  Centre code: XC5913
  Address of School/College: Yenepoya Pre-University college Jeppinamogaru-NH66 Mangalore-575009
  Pin: 575009
  Contact Nos:
  Email: info@yenepoyapuc.com
  Aggregate Percentage: 87
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 89 89
Chemistry 100 81 81
Mathematics 100 91 91
Physics, Chemistry & Mathematics combined Percentage: 87
English 100 83 83
   
IMU CET Application Number:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
MONTH / YEAR (MM/YYYY) SPORT/ACTIVITY LEVEL OF PARTICIPATION POSITION
11/2016 1500m Running Race School Third
11/2016 Kabaddi School First
11/2016 Volleyball School Second
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: Preparing for the test and interview
Why do you wish to join TMI?: One of the best colleges for DNS in India
What are your hobbies?: Playing,Reading, writing, Traveling
What are your strengths?: I can overcome my weakness , Punctuality
What are your weaknesses?: Procrastination,Too much Kind
How do you intend to meet the expenses of this program?: Bank Loan
 
Review you documents:
Birth certificate DGS Approved Medical Fitness Certificate not uploaded Class X marksheet School leaving certificate not uploaded Class XII admit card Class XII marksheet
 
Declaration

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

Signature of Candidate

 

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Date ________________

 
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