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

Application Summary: Diploma in Nautical Science
Dossier ID: DNS2050418 Name: Manik Rustagi
  Address: Ward No.4,Session Road Below TCCR,Library
Telephone No.: Mobile no: 7988083994
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 306268215
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2050418 are true and correct.
Signature of Candidate Signature of Parent/Guardian



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:, Web:
(New Admission Diploma in Nautical Science )


  Dossier ID: DNS2050418
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Manik Rustagi
Mother's Name: Archana Rustagi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 06 Aug 2001 Nationality: Indian
Place of Birth: Dharamshala Personal Identification Mark: Scar on left ankle
Blood Group: O + Address for Communication: Ward No.4,Session Road Below TCCR,Library
State: Himachal Pradesh Country: India
Pin: 176215 City/District: Dharamshala
Mobile no: 7988083994 Telephone No. with STD code:
Aadhar Card No:862425898152 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Rakesh Rustagi Relationship with candidate: Father
Parents Date of Birth: 30 May 1968 Parent's/Guardian's Occupation/Designation: Shopkeeper
Office Address:
Address: Ward No.4,Session road Below TCCR,Library
Country: India State: Himachal Pradesh
City/District: Dharamshala Pin: 176215
Tel: Mobile no.: 8894392789
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2019
Board: ISCE Board: CBSE
School: St.Thomas School School: Anuradha Public Sr. Sec. School
City: Jagadhri City: Palampur
English %: 86 Board Roll No./Seat No.: 2780665
Aggregate Percentage: 90 School/College Code: 23049
  Centre code: 2528
  Address of School/College: Maranda,H.P
  Pin: 176102
  Contact Nos:
  Aggregate Percentage: 85
Details of Marks Secured in (10+2) Examination -

Physics 100 79 79
Chemistry 100 86 86
Mathematics 100 95 95
Physics, Chemistry & Mathematics combined Percentage: 86.67
English 100 91 91
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: Weight Lifting,Learning swimming,preparing for IMU CET,
Why do you wish to join TMI?: I want to have a bright future as a deck officer and TMI is one of the best institutes to get into this field.
What are your hobbies?: Weight Lifting,playing video games
What are your strengths?: Self-Control and Delayed Gratification
What are your weaknesses?: I underestimate my abilities
How do you intend to meet the expenses of this program?: Own Resources
Review you documents:
Birth certificate DGS Approved Medical Fitness Certificate not uploaded Class X marksheet School leaving certificate Class XII admit card not uploaded Class XII marksheet

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

Signature of Candidate



Date ________________

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