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: DNS2176091 Name: Utkarsh mishra
  Address: Vill- Basdila khurd Post-Laxmipur babu Dist-Kushinagar Basdilla khurd kushinagar
Telephone No.: 08874472628 Mobile no: 9140119804
E-mail: utkarshm793@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 427839329
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2176091 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: DNS2176091
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: Utkarsh mishra
Mother's Name: Nikee devi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 07 Sep 2004 Nationality: Indian
Place of Birth: Kushinagar Personal Identification Mark: Cut mark on left hand thumb
Blood Group: B + Address for Communication: Vill- Basdila khurd Post-Laxmipur babu Dist-Kushinagar Basdilla khurd kushinagar
State: Uttar Pradesh Country: India
Pin: 274407 City/District: Kushinagar
Mobile no: 9140119804 Telephone No. with STD code: 08874472628
Aadhar Card No:644098395190 E-mail: utkarshm793@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: Kamlakar mishra Relationship with candidate: Father
Parents Date of Birth: 22 Feb 1982 Parent's/Guardian's Occupation/Designation: Farmer
   
Office Address:
   
Address: Vill- Basdila khurd Post-Laxmipur babu Dist-Kushinagar Basdilla khurd,kushinagar
Country: India State: Uttar Pradesh
City/District: Tamkuhi raj Pin: 274407
Tel: 08874472628 Mobile no.: 9140119804
Fax: Email: utkarshm793@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: Smart move academy School: Smart move academy
City: Gopalganj City: Kushinagar
English %: 70 Board Roll No./Seat No.:
Aggregate Percentage: 70 School/College Code:
  Centre code:
  Address of School/College: Vill- Basdila khurd Post-Laxmipur babu Dist-Kushinagar
  Pin: 274407
  Contact Nos: 08874472628
  Email: utkarshm793@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 ?: By get some mare knowledge about merchant navy .
Why do you wish to join TMI?: To make a secure future.
What are your hobbies?: Gymnasium
What are your strengths?: My confidence
What are your weaknesses?: My financial background
How do you intend to meet the expenses of this program?: Bank Loan
 
Review you documents:
Birth certificate DGS Approved Medical Fitness Certificate not uploaded Class X marksheet School leaving certificate Class XIIĀ 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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