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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: DNS2051270 |
Name: PATANKAR IBRAHIM SAMEER |
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Address: B/304 ASMITA ORCHID 1 NAYA NAGAR MIRA ROAD EAST |
| Telephone No.: |
Mobile no: 7400132232 |
| E-mail: ibrahimpatankar211001@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: 308603247 |
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| Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2051270 are true and correct. |
| Signature of Candidate |
Signature of Parent/Guardian |
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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: PATANKAR IBRAHIM SAMEER |
| Mother's Name: KANEEZ SAMEER PATANKAR |
| Gender (M/F): Male |
Marital Status (Single/Married): Single |
| Date of Birth (DD/MM/YY): 14 Aug 2001 |
Nationality: INDIAN |
| Place of Birth: MUMBAI |
Personal Identification Mark: STICH ON FOREHEAD |
| Blood Group: O + |
Address for Communication: B/304 ASMITA ORCHID 1 NAYA NAGAR MIRA ROAD EAST |
| State: Maharashtra |
Country: India |
| Pin: 401107 |
City/District: THANE |
| Mobile no: 7400132232 |
Telephone No. with STD code: |
| Aadhar Card No:511009567404 |
E-mail: ibrahimpatankar211001@gmail.com |
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| Guardian's Particulars: |
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| Name of Parent/Guardian: SAMEER IBRAHIM PATANKAR |
Relationship with candidate: FATHER |
| Parents Date of Birth: 24 Jun 1972 |
Parent's/Guardian's Occupation/Designation: SEAMAN |
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| Office Address: |
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| Address: NAYA NAGAR MIRA ROAD EAST |
| Country: India |
State: Maharashtra |
| City/District: THANE |
Pin: 401107 |
| Tel: |
Mobile no.: 9987949572 |
| Fax: |
Email: kaneezpatankar786@yahoo.com |
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Education and Academic Record :
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| Class X: - |
Class XII: - |
| Year of Passing: 2017 |
Year of Passing: 2019 |
| Board: Maharashtra |
Board: Maharashtra |
| School: N.H ENGLISH ACADEMY |
School: ROYAL COLLEGE |
| City: MIRA ROAD |
City: MIRA ROAD |
| English %: 66 |
Board Roll No./Seat No.: M027405 |
| Aggregate Percentage: 74 |
School/College Code: 875 |
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Centre code: 1401 |
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Address of School/College: PENKAR PADA, MIRA ROAD |
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Pin: 401107 |
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Contact Nos: |
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Email: info@royalcollegemiraroad.edu.in |
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Aggregate Percentage: 64 |
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| Details of Marks Secured in (10+2) Examination - |
| SUBJECTS |
MAXIMUM MARKS
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MARKS SECURED |
PERCENTAGE (%) |
| Physics |
100 |
63 |
63 |
| Chemistry |
100 |
60 |
60 |
| Mathematics |
100 |
78 |
78 |
| Physics, Chemistry & Mathematics combined Percentage: |
67 |
| English |
100 |
62 |
62 |
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| IMU CET Application Number: |
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| How do you intend spending your time after completing class XII Final exams and before joining college ?: PREPARATION OF ENTRANCE EXAM |
| Why do you wish to join TMI?: ELDER BROTHER REFER TO JOIN TMI |
| What are your hobbies?: FOOTBALL |
| What are your strengths?: SELF CONFIDENCE |
| What are your weaknesses?: I HAVE TROUBLE TO SAY NO |
| 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 not uploaded
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Class XII marksheet
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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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