Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail:, Web:
(New Admission Diploma in Nautical Science )


  Dossier ID: DNS2175550
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Shivananad yadav
Mother's Name: Shusila devi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 06 May 2004 Nationality: Indian
Place of Birth: Azamgarh Personal Identification Mark: Cut mark on right leg
Blood Group: A + Address for Communication: Village rastipur Post pittaupur, bansgaon District Azamgarh
State: Uttar Pradesh Country: India
Pin: 276126 City/District: Azamgarh
Mobile no: 8881090979 Telephone No. with STD code:
Aadhar Card No:474840244906 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Balkisun yadav Relationship with candidate: Father
Parents Date of Birth: 01 Jan 1970 Parent's/Guardian's Occupation/Designation: Farmer
Office Address:
Address: Village rastipur Post pittaupur, bansgaon District Azamgarh
Country: India State: Uttar Pradesh
City/District: Azamgarh Pin: 276126
Tel: Mobile no.: 8881090979
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: Skd Academy School: Skd Academy
City: Lucknow City: Lucknow
English %: 58 Board Roll No./Seat No.:
Aggregate Percentage: 58 School/College Code:
  Centre code:
  Address of School/College: Vikrant khand 2 Lucknow
  Pin: 226028
  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
08/2018 Running School level 1postition
How do you intend spending your time after completing class XII Final exams and before joining college ?: Reading book and watching movies
Why do you wish to join TMI?: For better education
What are your hobbies?: Football and volleyball
What are your strengths?: Running
What are your weaknesses?: Shame
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 ________________

Last date for payment of application fees has passed. No further application fee payment will be accepted.