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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: DNS2052553 |
Name: SAMAUN HAQUE RANA |
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Address: AT-BABHNI PO-MAHADEOPUR PS-PRANPUR DIST-KATIHAR DIST- KATIHAR |
| Telephone No.: |
Mobile no: 9006437945 |
| E-mail: samaunhaquektr@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: 311858103 |
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| Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2052553 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: SAMAUN HAQUE RANA |
| Mother's Name: SAKILA AKHTAR |
| Gender (M/F): Male |
Marital Status (Single/Married): Single |
| Date of Birth (DD/MM/YY): 13 Mar 2001 |
Nationality: INDIAN |
| Place of Birth: BABHNI |
Personal Identification Mark: RIGHT HAND SMALL CUT |
| Blood Group: B + |
Address for Communication: AT-BABHNI PO-MAHADEOPUR PS-PRANPUR DIST-KATIHAR DIST- KATIHAR |
| State: Bihar |
Country: India |
| Pin: 854116 |
City/District: KATIHAR |
| Mobile no: 9006437945 |
Telephone No. with STD code: |
| Aadhar Card No:790855615740 |
E-mail: samaunhaquektr@gmail.com |
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| Guardian's Particulars: |
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| Name of Parent/Guardian: NIZAMUL HAQUE |
Relationship with candidate: FATHER |
| Parents Date of Birth: 01 Jan 1964 |
Parent's/Guardian's Occupation/Designation: business |
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| Office Address: |
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| Address: AT-BABHNI PO-MAHADEOPUR PS-PRANPUR DIST KATIHAR DIST-KATIHAR |
| Country: India |
State: Bihar |
| City/District: KATIHAR |
Pin: 854116 |
| Tel: |
Mobile no.: 9934741151 |
| Fax: |
Email: nijamulhaquektr@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: Bihar |
Board: Bihar |
| School: U M S MAHADEOPUR PRANPUR KATIHAR |
School: SUR TTULSI INTER COLLEGE KATIHAR |
| City: KATIHAR |
City: KATIHAR |
| English %: 36 |
Board Roll No./Seat No.: 20010134 |
| Aggregate Percentage: 50 |
School/College Code: 94014 |
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Centre code: 1505 |
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Address of School/College: Sahisia, Katihar, Bihar 854107 |
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Pin: 854107 |
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Contact Nos: |
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Email: samaunhaquektr0786@gmail.com |
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Aggregate Percentage: 66 |
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| Details of Marks Secured in (10+2) Examination - |
| SUBJECTS |
MAXIMUM MARKS
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MARKS SECURED |
PERCENTAGE (%) |
| Physics |
100 |
68 |
68 |
| Chemistry |
100 |
65 |
65 |
| Mathematics |
100 |
73 |
73 |
| Physics, Chemistry & Mathematics combined Percentage: |
68.67 |
| English |
100 |
61 |
61 |
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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 ?: I will take my time knowing about the ship |
| Why do you wish to join TMI?: tmi is the best maritime academy and i want to study in because is my goal |
| What are your hobbies?: carrom |
| What are your strengths?: my own self confidence |
| What are your weaknesses?: nothing |
| 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 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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