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


  Dossier ID: DNS2173066
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Shivam Negi
Mother's Name: Asha Negi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 02 Nov 2001 Nationality: Indian
Place of Birth: Chamoli Personal Identification Mark: Mole on neck
Blood Group: A - Address for Communication: B-93 sector-4 Defence Colony
State: Uttaranchal Country: India
Pin: 248001 City/District: Dehradun
Mobile no: 7060048884 Telephone No. with STD code: 07060048884
Aadhar Card No:371140391885 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Asha Negi Relationship with candidate: Mother
Parents Date of Birth: 20 Nov 1972 Parent's/Guardian's Occupation/Designation: Housewife
Office Address:
Address: B-93 sector-4 Defence colony
Country: India State: Uttaranchal
City/District: Dehradun Pin: 248001
Tel: Mobile no.: 7055223355
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2019
Board: CBSE Board: CBSE
School: DAV Public School School: DAV Public School
City: Dehradun City: Dehradun
English %: 90 Board Roll No./Seat No.: 5809218
Aggregate Percentage: 90 School/College Code: 08880
  Centre code: 5536
  Address of School/College: sector-4 Defence colony
  Pin: 248001
  Contact Nos: 07060048884
  Aggregate Percentage: 74
Details of Marks Secured in (10+2) Examination -

Physics 100 72 72
Chemistry 100 64 64
Mathematics 100 54 54
Physics, Chemistry & Mathematics combined Percentage: 63.33
English 100 91 91
IMU CET Application Number:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
12/2018 Basketball National participation
12/2017 Basketball National Participation
05/2014 Basketball State Winner
12/2019 Basketball state Second Runner up
How do you intend spending your time after completing class XII Final exams and before joining college ?: I worked on my communication skills. Also I was practicing theatre and basketball.
Why do you wish to join TMI?: I believe that I can let my full potential out there.
What are your hobbies?: Basketball, volleyball, skating, writing and music
What are your strengths?: positive attitude, never giving up and determined towards my goal
What are your weaknesses?: sometimes overconfident
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.