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: DNS2174381 Name: Tushar Kumar Gupta
  Address: Shri ram nagar barbil
Telephone No.: Mobile no: 6372134574
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 425773111
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2174381 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: DNS2174381
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Tushar Kumar Gupta
Mother's Name: Usha Devi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 07 Feb 2002 Nationality: Indian
Place of Birth: Barbil Personal Identification Mark: Cut marks on nose
Blood Group: O + Address for Communication: Shri ram nagar barbil
State: Orissa Country: India
Pin: 758035 City/District: Barbil
Mobile no: 6372134574 Telephone No. with STD code:
Aadhar Card No:578521871278 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Ganesh Prasad Gupta Relationship with candidate: Father
Parents Date of Birth: 24 Oct 1980 Parent's/Guardian's Occupation/Designation: bussinessman
Office Address:
Address: Shri ram nagar barbil
Country: India State: Orissa
City/District: Barbil Pin: 758035
Tel: Mobile no.: 9437200277
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2020
Board: ISCE Board: CBSE
School: St Marys School School: Vikash Residential School
City: Barbil City: bhubaneswar
English %: 64 Board Roll No./Seat No.: 12613255
Aggregate Percentage: 78 School/College Code: 15521
  Centre code: 1579
  Address of School/College: deras road bhagabatipur, kantabada
  Pin: 752054
  Contact Nos:
  Aggregate Percentage: 84
Details of Marks Secured in (10+2) Examination -

Physics 100 88 88
Chemistry 100 85 85
Mathematics 100 89 89
Physics, Chemistry & Mathematics combined Percentage: 87.33
English 100 74 74
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: After completing my class XII exam I was spending most of the time reading books and playing indoor games as it was lockdown at that time I was at home and was spending my quality time with my family.
Why do you wish to join TMI?: Because Tolani is One Of the most reputed institute in India.
What are your hobbies?: Playing Cricket and Reading Books
What are your strengths?: creativity, focused, flexibility
What are your weaknesses?: self criticism
How do you intend to meet the expenses of this program?: Own Resources
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

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

Signature of Candidate



Date ________________

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