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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: DNS2050350 |
Name: YASH CHAURASIA |
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Address: SAI BABA GOLDI VASTRA BHANDAR MADHINATH BAREILLY |
| Telephone No.: |
Mobile no: 9634489408 |
| E-mail: CHAURASIA251198@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: 306037307 |
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| Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2050350 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: YASH CHAURASIA |
| Mother's Name: NEETA CHAURASIA |
| Gender (M/F): Male |
Marital Status (Single/Married): Single |
| Date of Birth (DD/MM/YY): 03 Aug 2001 |
Nationality: INDIAN |
| Place of Birth: BAREILLY |
Personal Identification Mark: MARK ON LEFT HAND |
| Blood Group: B + |
Address for Communication: SAI BABA GOLDI VASTRA BHANDAR MADHINATH BAREILLY |
| State: Uttar Pradesh |
Country: India |
| Pin: 243001 |
City/District: BAREILLY |
| Mobile no: 9634489408 |
Telephone No. with STD code: |
| Aadhar Card No:259591490227 |
E-mail: CHAURASIA251198@GMAIL.COM |
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| Guardian's Particulars: |
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| Name of Parent/Guardian: ANOOP KUMAR CHAURASIA |
Relationship with candidate: FATHER |
| Parents Date of Birth: 05 Jul 1978 |
Parent's/Guardian's Occupation/Designation: GOVERNMENT SERVICE |
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| Office Address: |
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| Address: ITAUA SUKHDEV PUR BUDAUN ROAD BAREILLY |
| Country: India |
State: Uttar Pradesh |
| City/District: BAREILLY |
Pin: 243001 |
| Tel: |
Mobile no.: 9675891951 |
| Fax: |
Email: CNEETAC@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: CBSE |
| School: M R S PUBLIC SCHOOL PILIBHIT BYPASS ROAD |
School: M R S PUBLIC SCHOOL PILLIBHIT BYPASS ROAD |
| City: BAREILLY |
City: BAREILLY |
| English %: 86 |
Board Roll No./Seat No.: 5642988 |
| Aggregate Percentage: 78 |
School/College Code: 54403 |
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Centre code: 5095 |
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Address of School/College: PILIBHIT BYPASS BAREILLY |
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Pin: 243001 |
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Contact Nos: |
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Email: SAURABHASTRA@GMAIL.COM |
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Aggregate Percentage: 72 |
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| Details of Marks Secured in (10+2) Examination - |
| SUBJECTS |
MAXIMUM MARKS
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MARKS SECURED |
PERCENTAGE (%) |
| Physics |
100 |
63 |
63 |
| Chemistry |
100 |
68 |
68 |
| Mathematics |
100 |
73 |
73 |
| Physics, Chemistry & Mathematics combined Percentage: |
68 |
| English |
100 |
77 |
77 |
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| IMU CET Application Number: |
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| How do you intend spending your time after completing class XII Final exams and before joining college ?: STUDY |
| Why do you wish to join TMI?: FOR POSITIVE FEEDBACK |
| What are your hobbies?: READING BOOKS |
| What are your strengths?: HONEST |
| What are your weaknesses?: TRUST EASILY |
| 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 not uploaded
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Class XII admit card not uploaded
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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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