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: DNS2051790 Name: Divyanshu SIngh
  Address: KD-108 GF-3 Kavi Nagar
Telephone No.: Mobile no: 9868576484
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 204.29 (Includes Convenience fee of ₹ 4.29 ) DD Number: -
Issuing Bank: - Transaction Id: 309583465
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2051790 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: DNS2051790
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Divyanshu SIngh
Mother's Name: Swati Singh
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 13 Mar 2003 Nationality: Indian
Place of Birth: Ghaziabad Personal Identification Mark: Black Mole on Left Hand Forearm
Blood Group: O + Address for Communication: KD-108 GF-3 Kavi Nagar
State: Uttar Pradesh Country: India
Pin: 201002 City/District: Ghaziabad
Mobile no: 9868576484 Telephone No. with STD code:
Aadhar Card No: E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Lok Pal Singh Relationship with candidate: Father
Parents Date of Birth: 13 Jan 1971 Parent's/Guardian's Occupation/Designation: Merchant Navy Officer
Office Address:
Address: KD-108 GF-3 Kavi Nagar
Country: India State: Uttaranchal
City/District: Ghaziabad Pin: 201002
Tel: Mobile no.: 9711879468
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2020
Board: Uttar Pradesh Board: Uttar Pradesh
School: Gurukul The School School: Gurukul The School
City: Ghaziabad City: Ghaziabad
English %: 89 Board Roll No./Seat No.:
Aggregate Percentage: 91 School/College Code:
  Centre code:
  Address of School/College: NH-24, 28 kms Delhi Milestone, Ghaziabad, U.P., INDIA
  Pin: 201302
  Contact Nos:
  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:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: I am preparing for competitive exams.
Why do you wish to join TMI?: I want to join marine career.
What are your hobbies?: Reading Books, Playing Football
What are your strengths?: I learn the new things quickly with curiosity
What are your weaknesses?: None
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 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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