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: DNS2051038 Name: SANGRAM RANA
  Address: 4TH LANE BASUDEV NAGAR KHODASINGHI BRAHAMPUR
Telephone No.: Mobile no: 7751054264
E-mail: sangramrana0908@gmail.com  
   
Application fee payment details:  
Payment Status: failure Payment Mode: Online
Amount: ₹ 200 DD Number: -
Issuing Bank: - Transaction Id: 308216254
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2051038 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: info@tmi.tolani.edu, Web: www.tolani.edu
(New Admission Diploma in Nautical Science )

APPLICATION FOR ADMISSION - 2020

 
  Dossier ID: DNS2051038
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: SANGRAM RANA
Mother's Name: SUGYANI RANA
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 09 Aug 2001 Nationality: INDIAN
Place of Birth: BHANJANAGAR Personal Identification Mark: CUT MARK ON LEFT EYE
Blood Group: O + Address for Communication: 4TH LANE BASUDEV NAGAR KHODASINGHI BRAHAMPUR
State: Orissa Country: India
Pin: 760010 City/District: GANJAM
Mobile no: 7751054264 Telephone No. with STD code:
Aadhar Card No:696585375631 E-mail: sangramrana0908@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: BABULA RANA Relationship with candidate: FATHER
Parents Date of Birth: 10 Jan 1970 Parent's/Guardian's Occupation/Designation: DEFENCE
   
Office Address:
   
Address: manipur northeast
Country: India State: Manipur
City/District: imphal west Pin: 795002
Tel: Mobile no.: 6371444844
Fax: Email: babularana153788@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2019
Board: CBSE Board: CBSE
School: ASSAM RIFLES PUBLIC SCHOOL AGARTALA School: ARMY PUBLIC SCHOOL GOPALPUR
City: AGARTALA City: BRAHAMPUR
English %: 86 Board Roll No./Seat No.: 6604598
Aggregate Percentage: 87 School/College Code: 09714
  Centre code: 6136
  Address of School/College: ARMY PUBLIC SCHOOL GOPALPUR
  Pin: 761052
  Contact Nos:
  Email: apsgopalpur@gmail.com
  Aggregate Percentage: 78
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 77 77
Chemistry 100 69 69
Mathematics 100 66 66
Physics, Chemistry & Mathematics combined Percentage: 70.67
English 100 77 77
   
IMU CET Application Number:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
MONTH / YEAR (MM/YYYY) SPORT/ACTIVITY LEVEL OF PARTICIPATION POSITION
01/2017 PARADE STATE LEVEL 1ST
10/2018 BASKET BALL SCHOOL LEVEL 2ND
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: preparing for exams
Why do you wish to join TMI?: i want a adventurous life
What are your hobbies?: cube solving
What are your strengths?: creativity
What are your weaknesses?: spelling mistake
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
 
Declaration

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

Signature of Candidate

 

___________________

Date ________________

 
Print Summary and Application Form