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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: DNS2050637 |
Name: KENNETH JOHN CAEIRO |
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Address: H. NO - 389 B, CAEIRO - NAGAR, BUTICAS II NAVELIM , SALCETE, GOA |
| Telephone No.: 00919011070570 |
Mobile no: 9011070570 |
| E-mail: kim1461caeiro@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: 306649421 |
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| Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2050637 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: KENNETH JOHN CAEIRO |
| Mother's Name: REENA VAZ |
| Gender (M/F): Male |
Marital Status (Single/Married): Single |
| Date of Birth (DD/MM/YY): 21 Sep 2002 |
Nationality: INDIAN |
| Place of Birth: GOA |
Personal Identification Mark: MOLE BEHIND LEFT KNEE |
| Blood Group: O + |
Address for Communication: H. NO - 389 B, CAEIRO - NAGAR, BUTICAS II NAVELIM , SALCETE, GOA |
| State: Goa |
Country: India |
| Pin: 403707 |
City/District: SOUTH GOA |
| Mobile no: 9011070570 |
Telephone No. with STD code: 00919011070570 |
| Aadhar Card No:673826273719 |
E-mail: kim1461caeiro@gmail.com |
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| Guardian's Particulars: |
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| Name of Parent/Guardian: MACS CAEIRO |
Relationship with candidate: FATHER |
| Parents Date of Birth: 06 Feb 1968 |
Parent's/Guardian's Occupation/Designation: PRIVATE SERVICE |
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| Office Address: |
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| Address: H. NO - 389 B, CAEIRO - NAGAR, BUTICAS II NAVELIM, SALCETE, GOA |
| Country: India |
State: Goa |
| City/District: SOUTH GOA |
Pin: 403707 |
| Tel: 9011070570 |
Mobile no.: 8600096880 |
| Fax: |
Email: macscaeiro2003@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: Goa |
Board: Goa |
| School: LOYOLA HIGH SCHOOL |
School: LOYOLA HIGHER SECONDARY SCHOOL |
| City: MARGAO |
City: MARGAO |
| English %: 74 |
Board Roll No./Seat No.: |
| Aggregate Percentage: 83 |
School/College Code: |
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Centre code: |
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Address of School/College: COMBA, MARGAO, GOA |
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Pin: 403601 |
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Contact Nos: 08322731474 |
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Email: loyolahss.2014@gmail.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 |
| 09/2019 |
FOOTBALL |
INTER COLLEGE |
GOAL KEEPER |
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| Vocational and Training Courses undertaken: |
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| MONTH / YEAR (MM/YYYY) |
COURSE |
COURSE DURATION |
| 04/2010 |
BASICS IN COMPUTER |
One month |
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| How do you intend spending your time after completing class XII Final exams and before joining college ?: Computer course continue |
| Why do you wish to join TMI?: Top ranking college for Marine studies. |
| What are your hobbies?: football, cricket, reading, travelling |
| What are your strengths?: good listener, decision making, communication skill, hard working, confident and daring personality |
| What are your weaknesses?: cooking |
| 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
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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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