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: Manish Raj
Mother's Name: Anita Kumari
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 26 Dec 2003 Nationality: Indian
Place of Birth: Rajauli Personal Identification Mark: Two black dot near left eye
Blood Group: O + Address for Communication: Gopal Nagar Rajauli,Near sinema hall Near bypass NH31
State: Bihar Country: India
Pin: 805125 City/District: Nawada
Mobile no: 6205766097 Telephone No. with STD code:
Aadhar Card No:511110723615 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Upendra Kumar Relationship with candidate: Father
Parents Date of Birth: 25 Nov 1970 Parent's/Guardian's Occupation/Designation: Teaching
Office Address:
Address: Gobind Pur Nawada
Country: India State: Bihar
City/District: Nawada Pin: 805125
Tel: Mobile no.: 9934733061
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: Bihar
School: D.A.V.Public School School: T.V.High School
City: Daudnagar City: Govindpur
English %: 79 Board Roll No./Seat No.: 21010127
Aggregate Percentage: 83 School/College Code: 23036
  Centre code: 23036
  Address of School/College: Govindpur , Nawada
  Pin: 805102
  Contact Nos: 09934733061
  Aggregate Percentage: 69
Details of Marks Secured in (10+2) Examination -

Physics 100 78 78
Chemistry 100 73 73
Mathematics 100 51 51
Physics, Chemistry & Mathematics combined Percentage: 67.33
English 100 67 67
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 ________________

Print Summary and Application Form