Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail:, Web:
(New Admission Diploma in Nautical Science )


  Dossier ID: DNS2172323
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Khan Mohammad Saud Mohd Mukeem
Mother's Name: Noor Jahan
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 12 Dec 2003 Nationality: India
Place of Birth: Uttar Prade Personal Identification Mark: Lumps on my Chest
Blood Group: A + Address for Communication: Room No.4/A Shinde Chawl Kadam Estate R.M Road Gulshan Nagar Oshiwara Joseghwari West Mumbai 62 ,Vill and Post Deoria Alawal Gonda , Uttar Pradesh
State: Maharashtra Country: India
Pin: 400102 City/District: Mumbai
Mobile no: 9967987354 Telephone No. with STD code:
Aadhar Card No:930985939051 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Mohd Mukeem Khan Relationship with candidate: Father
Parents Date of Birth: 01 Jan 1973 Parent's/Guardian's Occupation/Designation: Self Employed
Office Address:
Address: A1 Furniture Mart Shop No.17 , Chaturvedi Conpound opposite H.P patrol pump S.V. Road Oshiwara Bridge Jogeshwari west
Country: India State: Maharashtra
City/District: Mumbai Pin: 400102
Tel: Mobile no.: 9820878635
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Maharashtra Board: Maharashtra
School: K.H.M.W High School School: Shri Kishore Mangal Murti Junior College
City: Mumbai City: Mumbai
English %: 57 Board Roll No./Seat No.:
Aggregate Percentage: 68 School/College Code:
  Centre code:
  Address of School/College: Nallasoapara East , Vasai
  Pin: 401209
  Contact Nos:
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics, Chemistry & Mathematics combined Percentage:
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: I will prepare myself for better communication skills.
Why do you wish to join TMI?: Because TMI is the best Institute in India For Pre Sea Courses.
What are your hobbies?: Skating , Singing , Swimming etc.
What are your strengths?: Determination , Dedication , Patience
What are your weaknesses?: Lack of confidence sometimes.
How do you intend to meet the expenses of this program?: Own Resources
Review you documents:
Birth certificate not uploaded DGS Approved Medical Fitness Certificate not uploaded Class X marksheet not uploaded 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 ________________

Last date for payment of application fees has passed. No further application fee payment will be accepted.