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

APPLICATION FOR ADMISSION - 2021

 
  Dossier ID:
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: Prithvi Rastogi
Mother's Name: Anupma Rastogi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 12 Sep 2003 Nationality: Indian
Place of Birth: Lalkuan Personal Identification Mark: Left side upper lip black dot mark
Blood Group: B + Address for Communication: Subhash Nagar, Ward No. 5, Lalkuan, Nanital , uttarakhand - 262402 Lalkuan Nanital Uttarakhand
State: Uttaranchal Country: India
Pin: 262402 City/District: Nanital
Mobile no: 9756165351 Telephone No. with STD code: 07534004092
Aadhar Card No:972637532104 E-mail: prithvirastogi009@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: Kapil rastogi Relationship with candidate: Father and son
Parents Date of Birth: 02 Mar 1977 Parent's/Guardian's Occupation/Designation: Business
   
Office Address:
   
Address: Subhash Nagar, Ward No. 5, Lalkuan, Nanital , uttarakhand - 262402 Lalkuan Nanital Uttarakhand
Country: India State: Uttaranchal
City/District: Nanital Pin: 262402
Tel: 07534004092 Mobile no.: 7534004092
Fax: Email: kapil.kapil.rastogi@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Uttaranchal Board: Uttaranchal
School: S V M H S S KICHHA U S N School: Govt Inter College CHUKTI DEORIA U S N
City: Kichha City: Kichha
English %: 60 Board Roll No./Seat No.:
Aggregate Percentage: 72 School/College Code:
  Centre code:
  Address of School/College: Chutki Deoria near toll plaza Rudrapur road kichha u s nagar 263148 Uttarakhand
  Pin: 263148
  Contact Nos: 07534004092
  Email: prithvirastogi009@gmail.com
  Aggregate Percentage:
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100
Chemistry 100
Mathematics 100
Physics, Chemistry & Mathematics combined Percentage:
English 100
   
IMU CET Application Number:  
 
How do you intend spending your time after completing class XII Final exams and before joining college ?:
Why do you wish to join TMI?:
What are your hobbies?:
What are your strengths?:
What are your weaknesses?:
How do you intend to meet the expenses of this program?: 
 
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
 
Declaration

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

Signature of Candidate

 

___________________

Date ________________

 
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