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


  Dossier ID: DNS2177626
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Pankaj kumar
Mother's Name: Bholi devi
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 28 Feb 2004 Nationality: Indian
Place of Birth: Begusarai Personal Identification Mark: A mole on left side of nose
Blood Group: B + Address for Communication: Basudevpur P.o.-koriya dist-begusarai Bihar pin- 851127
State: Bihar Country: India
Pin: 851127 City/District: Begusarai
Mobile no: 7280907806 Telephone No. with STD code:
Aadhar Card No:617307410646 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Rajiv roy Relationship with candidate: Father
Parents Date of Birth: 01 Jan 1974 Parent's/Guardian's Occupation/Designation: Farming
Office Address:
Address: Basudevpur koriya Begusarai 851127
Country: India State: Bihar
City/District: Begusarai Pin: 851127
Tel: Mobile no.: 9570223436
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: Jawahar navodaya vidyalaya bishnupur begusarai School: Jnv begusarai
City: Begusarai City: Begusarai
English %: 74 Board Roll No./Seat No.:
Aggregate Percentage: 82 School/College Code:
  Centre code:
  Address of School/College: Bishnupur bwgusarai
  Pin: 851101
  Contact Nos: 06243223032
  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:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: Yes
Why do you wish to join TMI?: Yes
What are your hobbies?: Playing
What are your strengths?: Playing
What are your weaknesses?: No
How do you intend to meet the expenses of this program?: Own Resources,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 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 ________________

Last date for payment of application fees has passed. No further application fee payment will be accepted.