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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: DNS2049856 |
Name: Gajra Vishal Mahesh |
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Address: 11 kailash bhuvan Dindayal road Dombivali west |
| Telephone No.: |
Mobile no: 9833785497 |
| E-mail: vg934805@gmail.com |
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| Application fee payment details: |
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| Payment Status: Paid |
Payment Mode: Online |
| Amount: ₹ 202.12 (Includes Convenience fee of ₹ 2.12 ) |
DD Number: - |
| Issuing Bank: - |
Transaction Id: 304669252 |
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| Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2049856 are true and correct. |
| Signature of Candidate |
Signature of Parent/Guardian |
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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: Gajra Vishal Mahesh |
| Mother's Name: Geeta |
| Gender (M/F): Male |
Marital Status (Single/Married): Single |
| Date of Birth (DD/MM/YY): 27 Sep 2002 |
Nationality: Indian |
| Place of Birth: Dombivali |
Personal Identification Mark: Mole on chest |
| Blood Group: B + |
Address for Communication: 11 kailash bhuvan Dindayal road Dombivali west |
| State: Maharashtra |
Country: India |
| Pin: 421202 |
City/District: Thane |
| Mobile no: 9833785497 |
Telephone No. with STD code: |
| Aadhar Card No:865891189949 |
E-mail: vg934805@gmail.com |
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| Guardian's Particulars: |
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| Name of Parent/Guardian: Geeta Mahesh Gajra |
Relationship with candidate: Mother |
| Parents Date of Birth: 31 Oct 1976 |
Parent's/Guardian's Occupation/Designation: Housewife |
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| Office Address: |
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| Address: Bhiwandi road purna village Khandagre estate |
| Country: India |
State: Maharashtra |
| City/District: Thane |
Pin: 421302 |
| Tel: |
Mobile no.: 9930279010 |
| Fax: |
Email: riya.gajra@gmail.com |
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Education and Academic Record :
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| Class X: - |
Class XII: - |
| Year of Passing: 2018 |
Year of Passing: 2020 |
| Board: Maharashtra |
Board: Maharashtra |
| School: ST Therese Convent high school |
School: Royal junior college |
| City: Dombivali |
City: Dombivali |
| English %: 73 |
Board Roll No./Seat No.: |
| Aggregate Percentage: 85 |
School/College Code: |
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Centre code: |
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Address of School/College: Royal junior college dombivali east tilak
Cross road |
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Pin: 421201 |
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Contact Nos: |
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Email: royalcollegebl@ymail.com |
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Aggregate Percentage: |
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| Details of Marks Secured in (10+2) Examination - |
| SUBJECTS |
MAXIMUM MARKS
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MARKS SECURED |
PERCENTAGE (%) |
| Physics |
100 |
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| Chemistry |
100 |
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| Mathematics |
100 |
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| Physics, Chemistry & Mathematics combined Percentage: |
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| English |
100 |
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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 |
| 03/2019 |
Judo |
Got blue belt in judo |
1 st |
| 08/2015 |
Judo |
state |
2 nd |
| 08/2018 |
Judo |
District |
1st |
| 09/2019 |
Judo |
District |
1st |
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| How do you intend spending your time after completing class XII Final exams and before joining college ?: Judo and studying for cet and sponsorship exam |
| Why do you wish to join TMI?: Best institute which focus on quality study |
| What are your hobbies?: To play judo cricket and gym |
| What are your strengths?: Coordination teamwork understanding |
| What are your weaknesses?: Emotional |
| How do you intend to meet the expenses of this program?: Own Resources |
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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
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Class XII admit card
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Class XII marksheet not uploaded
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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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