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


  Dossier ID: DNS2176682
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Biplab mishra
Mother's Name: Pusparani dash
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 22 Jul 2003 Nationality: Indian
Place of Birth: DHENKANAL Personal Identification Mark: Mole at backside of neck
Blood Group: O + Address for Communication: At- Ratna bazar P.o- Dhenkanal R.S Dist-Dhenkanal
State: Orissa Country: India
Pin: 759013 City/District: Dhenkanal
Mobile no: 9439544724 Telephone No. with STD code: 09439544724
Aadhar Card No:333651104753 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Ashok kumar mishra Relationship with candidate: Father
Parents Date of Birth: 12 Dec 1962 Parent's/Guardian's Occupation/Designation: Lecturship
Office Address:
Address: At- Ratna bazar P.o- Dhenkanal R.S Dist-Dhenkanal
Country: India State: Orissa
City/District: Dhenkanal Pin: 759013
Tel: 06762228177 Mobile no.: 8280220077
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: Kendriya vidyalaya Dhenkanal School: Kendriya vidyalaya Dhenkanal
City: Dhenkanal City: Dhenkanal
English %: 89 Board Roll No./Seat No.:
Aggregate Percentage: 78 School/College Code:
  Centre code:
  Address of School/College: Banmali prasad , Bhapur, Dhenkanal,Odisha
  Pin: 759015
  Contact Nos: 09439544724
  Aggregate Percentage:
Details of Marks Secured in (10+2) Examination -

Physics 100
Chemistry 100
Mathematics 100
Physics, Chemistry & Mathematics combined Percentage:
English 100
IMU CET Application Number:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
06/2016 6th Indian open taekwondo cup National level 2nd
09/2019 34th odisha state taekwondo championship State level 1st
08/2016 Regional games and sports meet Regional level 2nd
08/2016 State junior taekwondo championship State level 2nd
How do you intend spending your time after completing class XII Final exams and before joining college ?: Playing sports
Why do you wish to join TMI?: It is one of the best colleges in India
What are your hobbies?: Sports and games
What are your strengths?: Sportive nature
What are your weaknesses?: Nothing
How do you intend to meet the expenses of this program?: Own Resources
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 ________________

Print Summary and Application Form