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: Ujjwal srivastava
Mother's Name: Pratibha srivastava
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 06 Jan 2000 Nationality: Indian
Place of Birth: Gorakhpur Personal Identification Mark: Mole on right palm
Blood Group: O + Address for Communication: Pratappur bansi siddharthnagar Pratappur bansi siddharthnagar
State: Uttar Pradesh Country: India
Pin: 272153 City/District: Siddharthnagar
Mobile no: 9807116666 Telephone No. with STD code:
Aadhar Card No:852834542146 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Balji srivastava Relationship with candidate: Father
Parents Date of Birth: 01 Jan 1970 Parent's/Guardian's Occupation/Designation: Farmer
Office Address:
Address: Pratappur bansi siddharthnagar Pratappur bansi siddharthnagar
Country: India State: Uttar Pradesh
City/District: Siddharthnagar Pin: 272153
Tel: Mobile no.: 9807116666
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2020
Board: Uttar Pradesh Board: Uttar Pradesh
School: J I C asidhawa chetia siddharthnagar School: R S R kumar I C bankuiyan siddharthnagar
City: Bansi City: Bansi
English %: 80 Board Roll No./Seat No.: 2352838
Aggregate Percentage: 79 School/College Code: 1115
  Centre code: 09533
  Address of School/College: Bankuiyan siddharthnagar
  Pin: 272153
  Contact Nos:
  Aggregate Percentage: 63
Details of Marks Secured in (10+2) Examination -

Physics 100 52 52
Chemistry 100 81 81
Mathematics 100 47 47
Physics, Chemistry & Mathematics combined Percentage: 60
English 100 75 75
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: By studying
Why do you wish to join TMI?: Tmi is best for DNS
What are your hobbies?: Singing
What are your strengths?: Panchuality
What are your weaknesses?: Honesty
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