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: DNS2174823 Name: Muhammed Sinan Noushad
  Address: Zain Thazhe Chovva Kannur
Telephone No.: Mobile no: 8129493144
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 202.12 (Includes Convenience fee of ₹ 2.12 ) DD Number: -
Issuing Bank: - Transaction Id: 426033431
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2174823 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: DNS2174823
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Muhammed Sinan Noushad
Mother's Name: Sufeera PP
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 06 Mar 2003 Nationality: Indian
Place of Birth: Kannur Personal Identification Mark: A black mole on the left side of the face
Blood Group: A + Address for Communication: Zain Thazhe Chovva Kannur
State: Kerala Country: India
Pin: 670018 City/District: Kannur
Mobile no: 8129493144 Telephone No. with STD code:
Aadhar Card No:203458152873 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Noushad VV Relationship with candidate: Father
Parents Date of Birth: 30 May 1974 Parent's/Guardian's Occupation/Designation: Machinist
Office Address:
Address: Abu Dhabi Dubai
Country: India State: Kerala
City/District: Others Pin: 670018
Tel: 09446660977 Mobile no.: 8129493144
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: Kerala
School: Chinmaya Vidyalaya School: Chovva Higher Secondary School
City: Kannur City: Kannur
English %: 83 Board Roll No./Seat No.:
Aggregate Percentage: 76 School/College Code:
  Centre code:
  Address of School/College: Chovva HSS Nee Chovva Kannur
  Pin: 670007
  Contact Nos:
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics 200
Chemistry 200
Mathematics 200
Physics, Chemistry & Mathematics combined Percentage:
English 100
IMU CET Application Number:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
06/2017 NCC School level LC
04/2021 Football Club Defender
How do you intend spending your time after completing class XII Final exams and before joining college ?: I learnt many things about this field. Also searched many of the colleges.
Why do you wish to join TMI?: Because of the placement records.
What are your hobbies?: Football, swimming
What are your strengths?: I am extrovert in nature.
What are your weaknesses?: I am not very good at singing.
How do you intend to meet the expenses of this program?: Own Resources,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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