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: DNS2172663 Name: Kanchan Adit Venkatesh
  Address: C - 108, Natvardham co-op hsc ltd Kharodi Village, Marve Road, Malad west
Telephone No.: Mobile no: 9967377132
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 424914659
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2172663 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: DNS2172663
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Kanchan Adit Venkatesh
Mother's Name: Jayalaxmi Kanchan
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 30 Aug 2002 Nationality: Indian
Place of Birth: Mumbai Personal Identification Mark: mole on left cheek
Blood Group: O + Address for Communication: C - 108, Natvardham co-op hsc ltd Kharodi Village, Marve Road, Malad west
State: Maharashtra Country: India
Pin: 400095 City/District: Mumbai
Mobile no: 9967377132 Telephone No. with STD code:
Aadhar Card No:397435092048 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Jayalaxmi Kanchan Relationship with candidate: Mothetr
Parents Date of Birth: 20 Sep 1974 Parent's/Guardian's Occupation/Designation: Service
Office Address:
Address: Shri Balaji International School Sunder Lane, Orlem, Malad west
Country: India State: Maharashtra
City/District: Mumbai Pin: 400064
Tel: 9967290081 Mobile no.: 9967290081
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2021
Board: ISCE Board: Maharashtra
School: Shri Balaji International School School: Patkar Varde College
City: Mumbai City: Mumbai
English %: 76 Board Roll No./Seat No.:
Aggregate Percentage: 86 School/College Code:
  Centre code:
  Address of School/College: Swami Vivekananda Rd, Piramal Nagar, Goregaon West
  Pin: 400104
  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
02/2013 Broad Jump School Level First position
11/2016 Basketball Tournament and Football Tournament School Level Basketball First position and Football Second position
12/2017 Basketball Tournament and Football Tournament and Cricket Tournament School Level First position in all three tournaments
12/2011 Geography olympiad Inter School Level Participation Certificates
Vocational and Training Courses undertaken:
04/2014 Basketball 4 years
06/2012 Dance Classes 2 years
How do you intend spending your time after completing class XII Final exams and before joining college ?: I would be spending my time preparing for my entrance exams and also would be gyming and working out to maintain a good health during this pandemic
Why do you wish to join TMI?: TMI is one of the best maritime institute across the country well known for its academic excellence and extra curricular activities. hence I wish to join TMI.
What are your hobbies?: I like playing different kind of sports. I have played Basketbll, Cricket, Football, Badminton, Handball etc. I like dancing and writing.
What are your strengths?: Self Motivated, Quick Learner, Learning from failures and mistakes, Being dedicates and persistaent towards my task
What are your weaknesses?: Overthinking
How do you intend to meet the expenses of this program?: Bank Loan
Review you documents:
Birth certificate DGS Approved Medical Fitness Certificate not uploaded Class X marksheet School leaving certificate Class XII admit card 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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