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 2021)


Application Summary: Diploma in Nautical Science
 
Dossier ID: DNS2175907 Name: Kuzhivila Jacob John
  Address: Flat no 204, Safari Complex Opp Navin Fluorine, Bhesthan, Surat.
Telephone No.: Mobile no: 9408487861
E-mail: 2102jacobjohn@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 430299044
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2175907 are true and correct.
Signature of Candidate Signature of Parent/Guardian
   
   

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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: info@tmi.tolani.edu, Web: www.tolani.edu
(New Admission Diploma in Nautical Science )

APPLICATION FOR ADMISSION - 2021

 
  Dossier ID: DNS2175907
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: Kuzhivila Jacob John
Mother's Name: Ammini John
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 21 Dec 2002 Nationality: Indian
Place of Birth: Punalur Personal Identification Mark: A small black mole below nose
Blood Group: A + Address for Communication: Flat no 204, Safari Complex Opp Navin Fluorine, Bhesthan, Surat.
State: Gujarat Country: India
Pin: 390523 City/District: Surat
Mobile no: 9408487861 Telephone No. with STD code:
Aadhar Card No:735607502716 E-mail: 2102jacobjohn@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: John Unnunni Relationship with candidate: Father
Parents Date of Birth: 20 May 1969 Parent's/Guardian's Occupation/Designation: Fabrication Works
   
Office Address:
   
Address: Laxmi Engineering Company Plot No. 258/8-9, Near Shiv Vijay Processors, G.I.D.C, Pandesara, Surat.
Country: India State: Gujarat
City/District: Surat Pin: 394221
Tel: Mobile no.: 9825795282
Fax: Email: unnunnijohn@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Gujarat Board: Gujarat
School: Mary Matha Public School School: Mary Matha Public School
City: Surat City: Surat
English %: 84 Board Roll No./Seat No.:
Aggregate Percentage: 87 School/College Code:
  Centre code:
  Address of School/College: 1120, post box, Batliboi Company, Near, Society, Bhedwad, Pramukh Park, Udhna, Surat, Gujarat 394220
  Pin: 394223
  Contact Nos:
  Email: principalmarymatha@yahoo.co.in
  Aggregate Percentage:
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 150
Chemistry 150
Mathematics 100
Physics, Chemistry & Mathematics combined Percentage:
English 100
   
IMU CET Application Number:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
MONTH / YEAR (MM/YYYY) SPORT/ACTIVITY LEVEL OF PARTICIPATION POSITION
01/2018 Shot Put Inter School 3rd
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: I would like to spend my time in maintaining my physical fitness and in reading books
Why do you wish to join TMI?: I wish to join TMI because its one of the best institute in India for maritime courses.
What are your hobbies?: Reading, Dancing and playing quizes
What are your strengths?: Memory Power and good in studies
What are your weaknesses?: Not good in sports
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
 
Declaration

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

Signature of Candidate

 

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Date ________________

 
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