Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail:, Web:
(New Admission Diploma in Nautical Science 2021)

Application Summary: Diploma in Nautical Science
Dossier ID: DNS2172406 Name: Yogeshkumar Trilokinath Gupta
  Address: A/103 aster ameya Yashwant nagar
Telephone No.: 07709736139 Mobile no: 7709736139
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ 2.12 ) DD Number: -
Issuing Bank: - Transaction Id: 424801967
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2172406 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: DNS2172406
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Yogeshkumar Trilokinath Gupta
Mother's Name: Guddidevi Trilokinath Gupta
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 28 Apr 2003 Nationality: Indian
Place of Birth: Virar Personal Identification Mark: On right palm there is mole
Blood Group: AB - Address for Communication: A/103 aster ameya Yashwant nagar
State: Maharashtra Country: India
Pin: 401303 City/District: Virar
Mobile no: 7709736139 Telephone No. with STD code: 07709736139
Aadhar Card No:979186088760 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Trilokinath Gupta Relationship with candidate: Father
Parents Date of Birth: 14 Aug 1980 Parent's/Guardian's Occupation/Designation: Real Estate agent
Office Address:
Address: Shop no. 3 Swastik arcade Opp sachin auto service center
Country: India State: Maharashtra
City/District: Virar Pin: 401303
Tel: 07709736139 Mobile no.: 9764981834
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Maharashtra Board: Maharashtra
School: Vidhya Vihar English High School School: Utkarsha Madhyamik Vidyalaya and Junior College
City: Virar City: Virar
English %: 66 Board Roll No./Seat No.:
Aggregate Percentage: 74 School/College Code:
  Centre code:
  Address of School/College: Bolinj opp dmart
  Pin: 401303
  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:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
12/2019 Quiz competition Taluka level club organisation 2
How do you intend spending your time after completing class XII Final exams and before joining college ?: Preparation for imucet and sponsorship tests.
Why do you wish to join TMI?: Because the fees of the college is less than other college and the campus of the college is also good.
What are your hobbies?: Reading,playing cricket,badminton,carrom
What are your strengths?: I can have leadership quality
What are your weaknesses?: Stage fear
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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