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: DNS2050633 Name: MADHAV VISHWAKARMA
  Address: VILL GORIYAPUR POST NAUPERWA VILL GORIYAPUR POST NAUPERWA
Telephone No.: Mobile no: 7084485953
E-mail: madhavvis29125@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 282.6 (Includes Convenience fee of ₹ 82.6 ) DD Number: -
Issuing Bank: - Transaction Id: 306648077
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2050633 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: DNS2050633
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: MADHAV VISHWAKARMA
Mother's Name: MAMTA VISHWAKARMA
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 29 Dec 2001 Nationality: INDIAN
Place of Birth: JAUNPUR Personal Identification Mark: CUT MARK ON LEFT EYEBROW
Blood Group: B + Address for Communication: VILL GORIYAPUR POST NAUPERWA VILL GORIYAPUR POST NAUPERWA
State: Uttar Pradesh Country: India
Pin: 222109 City/District: JAUNPUR
Mobile no: 7084485953 Telephone No. with STD code:
Aadhar Card No:833149282780 E-mail: madhavvis29125@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: RADHEY SHYAM VISHWAKARMA Relationship with candidate: FATHER
Parents Date of Birth: 13 Jun 1983 Parent's/Guardian's Occupation/Designation: FARMER
   
Office Address:
   
Address: VILL GORIYAPUR POST NAUPERWA VILL GORIYAPUR POST NAUPERWA
Country: India State: Uttar Pradesh
City/District: JAUNPUR Pin: 222109
Tel: Mobile no.: 9682242355
Fax: Email: RAGHAVRAIL@GMAIL.COM
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2020
Board: Uttar Pradesh Board: Uttar Pradesh
School: S RAM KISHORE SMIRITI BALIKA INTER COLLAGE BELAPAR School: S RAM KISHORE SMIRITI BALIKA INTER COLLAGE BELAPAR
City: JAUNPUR City: JAUNPUR
English %: 53 Board Roll No./Seat No.:
Aggregate Percentage: 62 School/College Code:
  Centre code:
  Address of School/College: VILL BELAPAR POST NAUPERWA JAUNPUR PIN 222109
  Pin: 222109
  Contact Nos:
  Email: abc@gmail.com
  Aggregate Percentage:
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100
Chemistry 100
Mathematics 100
Physics, Chemistry & Mathematics combined Percentage:
English 100
   
IMU CET Application Number:  
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: To Do maritime course or B.Sc by Collage
Why do you wish to join TMI?: BEST MARINE INSTITUTE
What are your hobbies?: READING BOOKS WITH OUT DOOR PLAYING
What are your strengths?: TO DO WORK CONTINUOUSLY
What are your weaknesses?: NO WEAKNESS
How do you intend to meet the expenses of this program?: Own Resources,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 not uploaded Class XII marksheet not uploaded
 
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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