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


  Dossier ID:
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Dillon OConnor
Mother's Name: Cynthia OConnor
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 14 Sep 2000 Nationality: Indian
Place of Birth: Bilaspur Personal Identification Mark: Scar on left eye brow
Blood Group: A + Address for Communication: Rama World, Phase-2, B-11 Raipur Road,Tifra
State: Chattisgarh Country: India
Pin: 495001 City/District: Bilaspur
Mobile no: 7999322126 Telephone No. with STD code: 7999322126
Aadhar Card No:282799769733 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Cynthia OConnor Relationship with candidate: Mother
Parents Date of Birth: 04 Nov 1961 Parent's/Guardian's Occupation/Designation: Special Assistant, PNB
Office Address:
Address: Budhwari Branch,Railway Colony Railway Reserve
Country: India State: Chattisgarh
City/District: Bilaspur Pin: 495001
Tel: Mobile no.: 9893234469
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2015 Year of Passing: 2017
Board: ISCE Board: CBSE
School: The Bishop School School: Sri Chaitanya Vidya Niketan
City: Pune City: Vizag
English %: 66 Board Roll No./Seat No.: 4631712
Aggregate Percentage: 71 School/College Code: 06293
  Centre code: 530011
  Address of School/College: Plot no. 18-102/1, Gurukulam Street, Marikavalasa Rd, near Toyota Showroom, Madhurawada, Visakhapatnam, Andhra Pradesh
  Pin: 530041
  Contact Nos: 7999322126
  Aggregate Percentage: 74
Details of Marks Secured in (10+2) Examination -

Physics 100 83 83
Chemistry 100 77 77
Mathematics 100 52 52
Physics, Chemistry & Mathematics combined Percentage: 70.67
English 100 84 84
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

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

Signature of Candidate



Date ________________

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