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


  Dossier ID: DNS2176229
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Shital Gupta
Mother's Name: Babita Devi
Gender (M/F): Female Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 26 Aug 2002 Nationality: Indian
Place of Birth: Azamgarh Personal Identification Mark: A Mole on face
Blood Group: B + Address for Communication: Post-Chhittepur,Hydrabad,Azamgarh Uttar Pradesh Chhittepur Azamgarh uttar Pradesh Phoolpur, Azamgarh Uttar Pardesh
State: Uttar Pradesh Country: India
Pin: 223226 City/District: Azamgarh
Mobile no: 7080736769 Telephone No. with STD code: 7080736769
Aadhar Card No:972996175124 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Manoj Gupta Relationship with candidate: Father
Parents Date of Birth: 25 May 1973 Parent's/Guardian's Occupation/Designation: Business
Office Address:
Address: Post-Chhittepur,Hydrabad, Pushpnagar Azamgarh Uttar Pradesh Post- Chhittepur, Hydrabad, Pushpnagar Azamgarh Uttar Pradesh
Country: India State: Uttar Pradesh
City/District: Azamgarh Pin: 223226
Tel: Mobile no.: 9616957541
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2019
Board: Uttar Pradesh Board: Uttar Pradesh
School: Kumudini Hadawa Azamgarh School: Om Prakash Inter College Fulesh Azamgarh
City: Azamgarh City: Azamgarh
English %: 89 Board Roll No./Seat No.: 1733035
Aggregate Percentage: 80 School/College Code: 1645
  Centre code: 06655
  Address of School/College: Azamgarh
  Pin: 223226
  Contact Nos: 7080736769
  Aggregate Percentage: 72
Details of Marks Secured in (10+2) Examination -

Physics 100 82 82
Chemistry 100 71 71
Mathematics 100 63 63
Physics, Chemistry & Mathematics combined Percentage: 72
English 100 64 64
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: Karate,Yoga,Study,Dance
Why do you wish to join TMI?: to complete my DNS Course
What are your hobbies?: Dance
What are your strengths?: I complete to my work on the time and I am too strong
What are your weaknesses?: I am always happy
How do you intend to meet the expenses of this program?: Bank Loan
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 XIIĀ 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.