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


  Dossier ID: DNS2175569
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Shivam upadhyay
Mother's Name: Bindu upadhyay
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 15 May 2003 Nationality: Indian
Place of Birth: Jaunpur Personal Identification Mark: Scretch on forehead
Blood Group: AB + Address for Communication: Ghagharpara Baharipur Jaunpur
State: Uttar Pradesh Country: India
Pin: 212275 City/District: Jaunpur
Mobile no: 7307219227 Telephone No. with STD code:
Aadhar Card No: E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Bindu upadhyay Relationship with candidate: Mother
Parents Date of Birth: 12 Jan 1984 Parent's/Guardian's Occupation/Designation: House wife
Office Address:
Address: Ghagharpara Baharipur Jaunpur
Country: India State: Uttar Pradesh
City/District: Jaunpur Pin: 212275
Tel: Mobile no.: 8127327970
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2020
Board: CBSE Board: CBSE
School: Navodaya vidya mandir School: Bhonwal convent school
City: Ramipur City: Lucknow
English %: 72 Board Roll No./Seat No.: 23678047
Aggregate Percentage: 72 School/College Code: 70976
  Centre code: 7204
  Address of School/College: Natkur, Bijnaur, Lucknow, Uttar Pradesh
  Pin: 226001
  Contact Nos:
  Aggregate Percentage: 78
Details of Marks Secured in (10+2) Examination -

Physics 100 79 79
Chemistry 100 76 76
Mathematics 100 69 69
Physics, Chemistry & Mathematics combined Percentage: 74.67
English 100 80 80
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: Between this period I always try to get knowledge of any kind ,watching some movies,comedy serials,try to earn online money.
Why do you wish to join TMI?: I want to join Tolani maritime institute because this institute provide best education and other facilities as well and here students learn everything practically.
What are your hobbies?: My hobby is to group discussion with my friends,watching comedy serials and movies and playing cricket.
What are your strengths?: My strength is my leadership quality.
What are your weaknesses?: Some time I become emotional.
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.