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


  Dossier ID:
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Appearing
Mother's Name: Lilavati
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 11 Jun 2003 Nationality: Indian
Place of Birth: Virar Personal Identification Mark: Tattoo
Blood Group: O + Address for Communication: Ambo smruti pp marg, near Rajasthan marble, virat west Ambo smruti pp marg, near Rajasthan marble, virat west
State: Maharashtra Country: India
Pin: 401303 City/District: Palghar
Mobile no: 8983256298 Telephone No. with STD code: 08983256290
Aadhar Card No:569480474150 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Jayram badhu kushwaha Relationship with candidate: Son
Parents Date of Birth: 01 Jan 1980 Parent's/Guardian's Occupation/Designation: Businesses man
Office Address:
Address: Ambo smruti pp marg, near Rajasthan marble, virat west Ambo smruti pp marg, near Rajasthan marble, virat west
Country: India State: Maharashtra
City/District: Palghar Pin: 401303
Tel: 08788286448 Mobile no.: 8788286448
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Maharashtra Board: Maharashtra
School: Achole english medium school School: Viva college
City: Virar City: Virar
English %: 58 Board Roll No./Seat No.:
Aggregate Percentage: 86 School/College Code:
  Centre code:
  Address of School/College: Viva college, near dmart virat wet
  Pin: 401303
  Contact Nos:
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics, Chemistry & Mathematics combined Percentage:
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: READING BOOKS
Why do you wish to join TMI?: Best college for dns
What are your hobbies?: Dancing
What are your strengths?: Leadership quality
What are your weaknesses?: Stage fear
How do you intend to meet the expenses of this program?: Bank Loan
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 ________________

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