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: DNS2177544 Name: Gautam Kumar
  Address: C/o Krishna Kumar Pandey, Nazir Building Lane, House No.- E/267, Road No.-4, New Colony, Brahampura
Telephone No.: Mobile no: 7667619480
E-mail: mk34355601@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 428245814
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2177544 are true and correct.
Signature of Candidate Signature of Parent/Guardian
   
   

___________________

___________________

   
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: DNS2177544
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: Gautam Kumar
Mother's Name: Renu Kumari
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 21 May 2004 Nationality: Indian
Place of Birth: Muzaffarpur Personal Identification Mark: A cut mark on the right side of fore head
Blood Group: O + Address for Communication: C/o Krishna Kumar Pandey, Nazir Building Lane, House No.- E/267, Road No.-4, New Colony, Brahampura
State: Bihar Country: India
Pin: 842003 City/District: Muzaffarpur
Mobile no: 7667619480 Telephone No. with STD code:
Aadhar Card No:242246051213 E-mail: mk34355601@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: Manoj Kumar Relationship with candidate: Father
Parents Date of Birth: 17 Feb 1974 Parent's/Guardian's Occupation/Designation: Government Employee
   
Office Address:
   
Address: District Agricultural Office Mushahari
Country: India State: Bihar
City/District: Muzaffarpur Pin: 843104
Tel: Mobile no.: 9852403539
Fax: Email: mk34355601@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: DAV Public School School: G D Mission Public School
City: Muzaffarpur City: Muzaffarpur
English %: 94 Board Roll No./Seat No.:
Aggregate Percentage: 91 School/College Code:
  Centre code:
  Address of School/College: Gopinathpur Dokra, Saraiya, Muuzaffarpur, Bihar
  Pin: 843106
  Contact Nos:
  Email: gdmissionpublicschool@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:  
Sports & Extra Curricular Activities:
Achievements in Sports and Extra Curricular Activities
MONTH / YEAR (MM/YYYY) SPORT/ACTIVITY LEVEL OF PARTICIPATION POSITION
12/2021 International Olympiad of Mathematics International 4402
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: I want to intend some of my time with my family to feel some relaxation after attempting all the exams.
Why do you wish to join TMI?: I wish to join TMI because it gives opportunity to apply in many shipping companies and the study is affordable in this institute.
What are your hobbies?: Hard working, Coding in computer
What are your strengths?: Good learner, Hard worker, Never giving up
What are your weaknesses?: Drawing, Exercise
How do you intend to meet the expenses of this program?: Own Resources
 
Review you documents:
Birth certificate DGS Approved Medical Fitness Certificate not uploaded Class X marksheet School leaving certificate Class XII 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

 

___________________

Date ________________

 
Print Summary and Application Form