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: Rajat Yadav
Mother's Name: Kusum Yadav
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 03 Nov 1999 Nationality: Indian
Place of Birth: Somnath Personal Identification Mark: Stitch mark near left eye
Blood Group: B + Address for Communication: F-166 New North Colony , Ambujanagar , Kodinar F-166 New North Colony , Ambujanagar , Kodinar
State: Gujarat Country: India
Pin: 362715 City/District: GirSomnath
Mobile no: 7069427299 Telephone No. with STD code: 02795
Aadhar Card No:270132331764 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Ram sajivan Yadav Relationship with candidate: Father
Parents Date of Birth: 09 Sep 1964 Parent's/Guardian's Occupation/Designation: Deputy Manager
Office Address:
Address: F-166 New North Colony , Ambujanagar , Kodinar F-166 New North Colony , Ambujanagar , Kodinar
Country: India State: Gujarat
City/District: GirSomnath Pin: 362715
Tel: Mobile no.: 9998582294
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2015 Year of Passing: 2017
Board: CBSE Board: CBSE
School: Ambuja Vidya Niketan School: Ambuja Vidya Niketan
City: GirSomnath City: GirSomnath
English %: 68 Board Roll No./Seat No.: 1602718
Aggregate Percentage: 76 School/College Code: 03013
  Centre code: 1103
  Address of School/College: F-166 New North Colony , Ambujanagar , Kodinar F-166 New North Colony , Ambujanagar , Kodinar
  Pin: 362715
  Contact Nos: 09998582294
  Aggregate Percentage: 76
Details of Marks Secured in (10+2) Examination -

Physics 100 71 71
Chemistry 100 79 79
Mathematics 100 78 78
Physics, Chemistry & Mathematics combined Percentage: 76
English 100 70 70
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: In the mean time i am doing Engineering .
Why do you wish to join TMI?: As the status of the college implies and the experience it hold in training cadets for a life long journey , I choose TMI as it will train me with the best facilities one can get.
What are your hobbies?: Sports , Music, Stage work
What are your strengths?: Compassionate about the job ,Always dedicate myself to the important works.
What are your weaknesses?: Till date i dont see a flaw in me but emotional backdown could be one .
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 ________________

Print Summary and Application Form