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: DNS2052024 Name: SHREYANSH PATTANAIK
  Address: C/O VINOD KUMAR NAYAK 2nd LANE,MUKUNDA MISHRA NAGAR,PURI
Telephone No.: Mobile no: 8887856717
E-mail: surenprasadpattanaik@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 202.12 (Includes Convenience fee of ₹ 2.12 ) DD Number: -
Issuing Bank: - Transaction Id: 310027713
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2052024 are true and correct.
Signature of Candidate Signature of Parent/Guardian
   
   

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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: DNS2052024
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: SHREYANSH PATTANAIK
Mother's Name: SNIGDHA RANI PATTANAIK
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 25 Jan 2000 Nationality: INDIAN
Place of Birth: NIRAKARPUR Personal Identification Mark: BLACK MOLE ON RIGHT SIDE FOREHEAD
Blood Group: O + Address for Communication: C/O VINOD KUMAR NAYAK 2nd LANE,MUKUNDA MISHRA NAGAR,PURI
State: Orissa Country: India
Pin: 752002 City/District: PURI
Mobile no: 8887856717 Telephone No. with STD code:
Aadhar Card No: E-mail: surenprasadpattanaik@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: SUREN PRASAD PATTANAIK Relationship with candidate: FATHER
Parents Date of Birth: 26 Jun 1972 Parent's/Guardian's Occupation/Designation: INDIAN ARMY
   
Office Address:
   
Address: RAISING CELL FOR FIELD SUB GROUP 33 CORPS.C/O 99 APO
Country: India State: West Bengal
City/District: SILIGURI Pin: 918033
Tel: Mobile no.: 8826789858
Fax: Email: surenprasadpattanaik@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2016 Year of Passing: 2019
Board: CBSE Board: CBSE
School: ARMY PUBLIC SCHOOL School: ARMY PUBLIC SCHOOL
City: LUCKNOW City: LUCKNOW
English %: 86 Board Roll No./Seat No.: 5711624
Aggregate Percentage: 82 School/College Code: 08572
  Centre code: 5255
  Address of School/College: ARMY PUBLIC SCHOOL,NEHRU ROAD,LUCKNOW,UTTAR PRADESH
  Pin: 226002
  Contact Nos:
  Email: apsnehruroadlucknow@gmail.com
  Aggregate Percentage: 74
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 55 55
Chemistry 100 72 72
Mathematics 100 71 71
Physics, Chemistry & Mathematics combined Percentage: 66
English 100 75 75
   
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
09/2016 BASKETBALL INTRA CLUSTER BASKETBALL TOURNAMENT CENTRAL COMMAND REGIONAL LEVEL FIRST
10/2016 BASKETBALL INTER CLUSTER BASKETBALL TOURNAMENT CENTRAL COMMAND DISTRICT LEVEL FOURTH
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: PLAYING
Why do you wish to join TMI?: GOOD INSTITUTE FOR MERCHANT NAVY COURSE
What are your hobbies?: PLAYING BASKETBALL
What are your strengths?: NEVER GIVE UP ATTITUDE
What are your weaknesses?: STUBBORN
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
 
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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