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: DNS2174299 Name: Atul Verma
  Address: B-32 Sant Jalaram bapu Nagar tilhari
Telephone No.: Mobile no: 9752563692
Application fee payment details:  
Payment Status: offline payment Payment Mode: Offline
Amount: DD Number: -
Issuing Bank: - Transaction Id: -
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2174299 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: DNS2174299
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Atul Verma
Mother's Name: Jyoti bala verma
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 01 Nov 2002 Nationality: Indian
Place of Birth: Orai Personal Identification Mark: Mark below right eye
Blood Group: O + Address for Communication: B-32 Sant Jalaram bapu Nagar tilhari
State: Madhya Pradesh Country: India
Pin: 482020 City/District: JABALPUR
Mobile no: 9752563692 Telephone No. with STD code:
Aadhar Card No:681227714546 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Virendra Singh Verma Relationship with candidate: Father
Parents Date of Birth: 06 Jul 1971 Parent's/Guardian's Occupation/Designation: Loco pilot
Office Address:
Address: Jabalpur Railway station
Country: India State: Madhya Pradesh
City/District: JABALPUR Pin: 482020
Tel: Mobile no.: 9752419355
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: Delhi public school School: Delhi public school
English %: 65 Board Roll No./Seat No.:
Aggregate Percentage: 60 School/College Code:
  Centre code:
  Address of School/College: Delhi public school Mandla road Jabalpur
  Pin: 482020
  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
10/2017 Sports Inter club 2nd
08/2018 Activity Inter class craft 1 st
08/2017 Activity Inter class craft Consolation
11/2019 Sports Inter dps Participation
How do you intend spending your time after completing class XII Final exams and before joining college ?: I love to travel so I will try to explore new places.
Why do you wish to join TMI?: As TMI is one of the best college in india .
What are your hobbies?: Travelling, gaming , outdoor sports
What are your strengths?: Supportive, friendly, many more
What are your weaknesses?: I think I have no weakness
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

I hereby declare that all the statements made above are true and correct.

Signature of Candidate



Date ________________

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