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: DNS2175052 Name: Nikhil Kumar Dubey
  Address: Vill-Sultanpur ,Post-Dariyawganj Vill-Sultanpur , Post-Dariyawganj
Telephone No.: Mobile no: 9044450597
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 426153922
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2175052 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: DNS2175052
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Nikhil Kumar Dubey
Mother's Name: Sangeeta Dubey
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 06 Mar 2003 Nationality: Indian
Place of Birth: Jaunpur Personal Identification Mark: Mole
Blood Group: O + Address for Communication: Vill-Sultanpur ,Post-Dariyawganj Vill-Sultanpur , Post-Dariyawganj
State: Uttar Pradesh Country: India
Pin: 222109 City/District: Jaunpur
Mobile no: 9044450597 Telephone No. with STD code:
Aadhar Card No: E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Bhagawan Shankar Dubey Relationship with candidate: Father
Parents Date of Birth: 02 Jan 1982 Parent's/Guardian's Occupation/Designation: Farmer
Office Address:
Address: Vill-Sultanpur ,Post-Dariyawganj Vill-Sultanpur , Post-Dariyawganj
Country: India State: Uttar Pradesh
City/District: Jaunpur Pin: 222109
Tel: Mobile no.: 9044450597
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2020
Board: CBSE Board: CBSE
School: Harihar Public School School: Harihar Public School
City: Jaunpur City: Jaunpur
English %: 72 Board Roll No./Seat No.: 23649729
Aggregate Percentage: 59 School/College Code: 70641
  Centre code: 7137
  Address of School/College: Vill-Kulhanamau , Jaunpur
  Pin: 222132
  Contact Nos:
  Aggregate Percentage: 60
Details of Marks Secured in (10+2) Examination -

Physics 100 54 54
Chemistry 100 66 66
Mathematics 100 63 63
Physics, Chemistry & Mathematics combined Percentage: 61
English 100 56 56
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: By study
Why do you wish to join TMI?: I want to join TMI as it is india best maritime institute. It has a good placement record
What are your hobbies?: Plying Volleyball
What are your strengths?: Self-control
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 not uploaded

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

Signature of Candidate



Date ________________

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