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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)
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| Application Summary: Diploma in Nautical Science |
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| Dossier ID: DNS2049760 |
Name: Mohammed Ashik Rahman |
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Address: Badriya house, Mudipu Azad Nagar Bantwal Taluk ,Mangalore-DK |
| Telephone No.: |
Mobile no: 7338213195 |
| E-mail: m.ashiq7426422@gmail.com |
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| Application fee payment details: |
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| Payment Status: Paid |
Payment Mode: Online |
| Amount: ₹ 200 (Includes Convenience fee of ₹ ) |
DD Number: - |
| Issuing Bank: - |
Transaction Id: 304389949 |
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| 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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___________________ |
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| Date ________________ |
Date ________________ |
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| 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. |
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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
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| Applicant's Personal Information: |
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| 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 |
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| Guardian's Particulars: |
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| Name of Parent/Guardian: Abdul Razak |
Relationship with candidate: Father |
| Parents Date of Birth: 13 Mar 1970 |
Parent's/Guardian's Occupation/Designation: Businessman |
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| Office Address: |
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| Address: Badriya house Mudipu |
| Country: India |
State: Karnataka |
| City/District: Dakshina Kannada |
Pin: 574153 |
| Tel: |
Mobile no.: 8550055448 |
| Fax: |
Email: assa67704@gmail.com |
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Education and Academic Record :
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| 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 |
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Centre code: XC5913 |
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Address of School/College: Yenepoya Pre-University college
Jeppinamogaru-NH66
Mangalore-575009 |
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Pin: 575009 |
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Contact Nos: |
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Email: info@yenepoyapuc.com |
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Aggregate Percentage: 87 |
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| Details of Marks Secured in (10+2) Examination - |
| SUBJECTS |
MAXIMUM MARKS
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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 |
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| IMU CET Application Number: |
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| 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 |
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| 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 |
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| Review you documents: |
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Birth certificate
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DGS Approved Medical Fitness Certificate not uploaded
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Class X marksheet
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School leaving certificate not uploaded
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Class XII admit card
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Class XII marksheet
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| 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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