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: DNS2051197 Name: Priyanshu Dalla
  Address: 3A/22, Luxmi Nagar,Rohtak,Haryana Ground Floor
Telephone No.: Mobile no: 8708431507
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 308477480
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2051197 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: DNS2051197
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Priyanshu Dalla
Mother's Name: Sunita
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 13 Aug 2002 Nationality: Indian
Place of Birth: Rohtak Personal Identification Mark: Minor cut on left side of forhead
Blood Group: A + Address for Communication: 3A/22, Luxmi Nagar,Rohtak,Haryana Ground Floor
State: Haryana Country: India
Pin: 124001 City/District: Rohtak
Mobile no: 8708431507 Telephone No. with STD code:
Aadhar Card No:542949405602 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Sunita Relationship with candidate: Mother
Parents Date of Birth: 01 Feb 1978 Parent's/Guardian's Occupation/Designation: Teacher
Office Address:
Address: Mdn Public School,Rohtak,Haryana Ground Floor
Country: India State: Haryana
City/District: Rohtak Pin: 124001
Tel: Mobile no.: 9812011814
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2020
Board: CBSE Board: CBSE
School: Mdn Public School School: Mdn Public School
City: Rohtak City: Rohtak
English %: 86 Board Roll No./Seat No.:
Aggregate Percentage: 89 School/College Code:
  Centre code:
  Address of School/College: Near New Bus Stand
  Pin: 124001
  Contact Nos: 9812011814
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics 100
Chemistry 100
Mathematics 100
Physics, Chemistry & Mathematics combined Percentage:
English 100
IMU CET Application Number:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
05/2018 Badminton Player 2nd Runner Up
10/2016 Interschool Techno Buzz Competitor 5th
04/2017 Academics Competitor 1st
How do you intend spending your time after completing class XII Final exams and before joining college ?: Revision of class 11th and 12th.Learning new things. Watching horror movies. Learn to drive a car.
Why do you wish to join TMI?: According to me TMI is the best college. It will enhance my skills and will eventually make me a better person.
What are your hobbies?: Listening to Music,Watching horror movies,Spending time with my family.
What are your strengths?: Good communication skills and good physical strength,good Badminton player.
What are your weaknesses?: Emotional towards my friends.
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 not uploaded Class XII admit card 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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