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: DNS2173171 Name: PRAKARSH SHUKLA
  Address: BHUJAULI KHAS, MUNSHI GORAKH NATH TOLA , DEORIA
Telephone No.: 7007584179 Mobile no: 7007584179
E-mail: akshatshukla890@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 426163023
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2173171 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: DNS2173171
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: PRAKARSH SHUKLA
Mother's Name: MANISHA SHUKLA
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 12 Jun 2002 Nationality: INDIAN
Place of Birth: DEORIA Personal Identification Mark: BIRTH MARK ON LEFTSIDE OF FOREHEAD
Blood Group: A + Address for Communication: BHUJAULI KHAS, MUNSHI GORAKH NATH TOLA , DEORIA
State: Uttar Pradesh Country: India
Pin: 274001 City/District: DEORIA
Mobile no: 7007584179 Telephone No. with STD code: 7007584179
Aadhar Card No:761957857952 E-mail: akshatshukla890@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: NAVEEN SHUKLA Relationship with candidate: FATHER
Parents Date of Birth: 01 Sep 1973 Parent's/Guardian's Occupation/Designation: BUSINESS
   
Office Address:
   
Address: JAIL ROAD , NEAR JAI HIND DHARMA KANTA , DEORIA
Country: India State: Uttar Pradesh
City/District: DEORIA Pin: 274001
Tel: Mobile no.: 7007979905
Fax: Email: naveendmw@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: SARASWATI VIDYA MANDIR School: R.B. CHILDRENS VALEEY SCHOOL
City: DEORIA City: DEORIA
English %: 83 Board Roll No./Seat No.:
Aggregate Percentage: 72 School/College Code:
  Centre code:
  Address of School/College: BELTHARA ROAD , BALLIYAN , DEORIA
  Pin: 274001
  Contact Nos:
  Email: akshatshukla890@gmail.com
  Aggregate Percentage:
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100
Chemistry 100
Mathematics 100
Physics, Chemistry & Mathematics combined Percentage:
English 100
   
IMU CET Application Number:  
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: MY XII BOARD IS NOT COMPLETED OVER YET BUT IF IT WAS COMPLETED I WANT TO WORK ON MY SKILLS AND PERSONALITY
Why do you wish to join TMI?: MERCHANT NAVY IS MY DREAM AND I KNOW TMI IS ONE OF THE WAY TO MY SUCCESS , AS JOINING THIS HONOURABLE INSTITUE MY KNOWLEDGE AND SKILLS CAN BE IMPROVED AND I CAN BE MY BEST
What are your hobbies?: PHOTOGRAPHY , COOKING
What are your strengths?: DEDICATION AND HONESTY
What are your weaknesses?: PUBLIC SPEAKING
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 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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