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 2021)


Application Summary: Diploma in Nautical Science
 
Dossier ID: DNS2172408 Name: Pushpendra Singh Chouhan
  Address: 9-B Jeevan Jyoti Colony Kalibillod, Sector-3 Pithampur Indore, Madhya Pradesh
Telephone No.: 07746941436 Mobile no: 7746941436
E-mail: pushpendra7401@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 424812927
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2172408 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 - 2021

 
  Dossier ID: DNS2172408
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: Pushpendra Singh Chouhan
Mother's Name: Basanti Chouhan
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 07 Apr 2001 Nationality: Indian
Place of Birth: Mhow Personal Identification Mark: Two moles on Neck
Blood Group: O + Address for Communication: 9-B Jeevan Jyoti Colony Kalibillod, Sector-3 Pithampur Indore, Madhya Pradesh
State: Madhya Pradesh Country: India
Pin: 453001 City/District: Indore
Mobile no: 7746941436 Telephone No. with STD code: 07746941436
Aadhar Card No:767661653713 E-mail: pushpendra7401@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: Sundarlal Chouhan Relationship with candidate: Son
Parents Date of Birth: 03 Mar 1966 Parent's/Guardian's Occupation/Designation: Government Service
   
Office Address:
   
Address: Janpad Panchayat Sardarpur Dhar, Madhya Pradesh
Country: India State: Madhya Pradesh
City/District: Dhar Pin: 454111
Tel: Mobile no.: 8085865739
Fax: Email: s.l.chouhan33@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2020
Board: CBSE Board: Madhya Pradesh
School: Mar Gregories Memorial English Medium School School: New Pithampur Public Senior Secondary School
City: Indore City: Dhar
English %: 70 Board Roll No./Seat No.: 205239227
Aggregate Percentage: 68 School/College Code: 522051
  Centre code: 521132
  Address of School/College: Indorama Square, Pithampur Sector no 3, Dhar
  Pin: 454774
  Contact Nos:
  Email: impuspendra70401@gmail.com
  Aggregate Percentage: 68
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 88 88
Chemistry 100 72 72
Mathematics 100 42 42
Physics, Chemistry & Mathematics combined Percentage: 67.33
English 100 66 66
   
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
11/2019 Singing Competition Inter School Winner
12/2019 Basketball Inter School Winner
01/2020 Debate Competition Inter School Runner up
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: I used to learn more and gather information about merchant navy since I intend to join this field.
Why do you wish to join TMI?: Because I have heard a lot of positive comments about TMI teaching facilities and infrastructure
What are your hobbies?: My hobbies include playing cricket and basketball, and I love to wrote poetries and songs as well.
What are your strengths?: My strengths are my discipline, hard work and dedication towards my work
What are your weaknesses?: Feel uncomfortable when my work is due or incomplete
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 not uploaded School leaving certificate not uploaded Class XII admit card not uploaded Class XII marksheet not uploaded
 
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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