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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: DNS2051678 |
Name: KANCHWALA INSIYA HATIM |
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Address: PATHAN MAZIL,MITHANAGAR,SURVEY NO 43 KONDHWA,PUNE |
| Telephone No.: |
Mobile no: 9545775995 |
| E-mail: insiyakanchwala5152@gmail.com |
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| Application fee payment details: |
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| Payment Status: Paid |
Payment Mode: Online |
| Amount: ₹ 200 (Includes Convenience fee of ₹ ) |
DD Number: - |
| Issuing Bank: - |
Transaction Id: 309344370 |
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| Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2051678 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: KANCHWALA INSIYA HATIM |
| Mother's Name: MASUMA |
| Gender (M/F): Female |
Marital Status (Single/Married): Single |
| Date of Birth (DD/MM/YY): 22 Dec 2001 |
Nationality: Indian |
| Place of Birth: PUNE |
Personal Identification Mark: MOLE ON NECK |
| Blood Group: O + |
Address for Communication: PATHAN MAZIL,MITHANAGAR,SURVEY NO 43 KONDHWA,PUNE |
| State: Maharashtra |
Country: India |
| Pin: 411048 |
City/District: PUNE |
| Mobile no: 9545775995 |
Telephone No. with STD code: |
| Aadhar Card No:482223623636 |
E-mail: insiyakanchwala5152@gmail.com |
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| Guardian's Particulars: |
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| Name of Parent/Guardian: MASUMA |
Relationship with candidate: MOTHER |
| Parents Date of Birth: 22 Aug 1982 |
Parent's/Guardian's Occupation/Designation: BEAUTICIAN |
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| Office Address: |
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| Address: PATHAN MAZIL,MITHANAGAR,SURVEY NO 43 KONDHWA,PUNE |
| Country: India |
State: Maharashtra |
| City/District: pune |
Pin: 411048 |
| Tel: |
Mobile no.: 9049537600 |
| Fax: |
Email: masumajabalpurwala5253@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: Maharashtra |
Board: Maharashtra |
| School: K TECH ACADEMY |
School: Poona College |
| City: PUNE |
City: PUNE |
| English %: 80 |
Board Roll No./Seat No.: |
| Aggregate Percentage: 72 |
School/College Code: |
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Centre code: |
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Address of School/College: CAMP, PUNE |
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Pin: 411042 |
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Contact Nos: |
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Email: principal@akipoonacollege.ac.in |
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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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| How do you intend spending your time after completing class XII Final exams and before joining college ?: PREPARING FOR IMU-CET exam |
| Why do you wish to join TMI?: its one of the best college in India |
| What are your hobbies?: DRAWING, LISTENING MUSIC |
| What are your strengths?: BADMINTON,RUNNING |
| What are your weaknesses?: NONE |
| How do you intend to meet the expenses of this program?: Bank Loan |
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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
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Class XII admit card not uploaded
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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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