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: DNS2050781 Name: Anurag N
  Address: Sreenilayam house peravoor Po peravoor
Telephone No.: Mobile no: 8086290396
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 204.83 (Includes Convenience fee of ₹ 4.83 ) DD Number: -
Issuing Bank: - Transaction Id: 307041618
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2050781 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: DNS2050781
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Anurag N
Mother's Name: Priya k
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 12 May 2000 Nationality: India
Place of Birth: Kerala Personal Identification Mark: A black mole on the right hand near middle finger
Blood Group: O + Address for Communication: Sreenilayam house peravoor Po peravoor
State: Kerala Country: India
Pin: 670673 City/District: Kannur
Mobile no: 8086290396 Telephone No. with STD code:
Aadhar Card No: E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Priya k Relationship with candidate: Mother
Parents Date of Birth: 08 Apr 1974 Parent's/Guardian's Occupation/Designation: Government employee
Office Address:
Address: Government thaluk hospital Koyilandi Po koyilandi
Country: India State: Kerala
City/District: Kozhikode Pin: 673305
Tel: Mobile no.: 9188321296
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2020
Board: CBSE Board: Kerala
School: Navajyothi eng med school School: Rajeev Gandhi memorial hss
City: Kannur City: Kannur
English %: 80 Board Roll No./Seat No.:
Aggregate Percentage: 94 School/College Code:
  Centre code:
  Address of School/College: Rajeev Gandhi memorial hss mokeri dt kannur
  Pin: 670692
  Contact Nos:
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics 200
Chemistry 200
Mathematics 200
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 ?: Engage in sports,Body building, travelling, try to gain new experiences
Why do you wish to join TMI?: Great Institute for marchant navy career
What are your hobbies?: Traveling,cooking
What are your strengths?: Ability to adjust with surroundings, takes inflexible decision , perfectionist, methodical,take responsibilities and task oriented
What are your weaknesses?: Eat less while enguaged in any serious task,family lover
How do you intend to meet the expenses of this program?: Own Resources,Bank Loan
Review you documents:
Birth certificate not uploaded DGS Approved Medical Fitness Certificate not uploaded Class X marksheet not uploaded School leaving certificate not uploaded Class XII admit card not uploaded Class XII marksheet not uploaded

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

Signature of Candidate



Date ________________

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