Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail:, Web:
(New Admission Diploma in Nautical Science 2021)

Application Summary: Diploma in Nautical Science
Dossier ID: DNS2178082 Name: Vailoyd Patricio Cardozo
  Address: Colleavaddo, Assolna Salcete Goa
Telephone No.: Mobile no: 8308194315
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 428883920
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2178082 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:, Web:
(New Admission Diploma in Nautical Science )


  Dossier ID: DNS2178082
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Vailoyd Patricio Cardozo
Mother's Name: Augusta Cardozo
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 30 Jun 2003 Nationality: Indian
Place of Birth: Margao Personal Identification Mark: Birth mark on left thigh
Blood Group: A + Address for Communication: Colleavaddo, Assolna Salcete Goa
State: Goa Country: India
Pin: 403701 City/District: South Goa
Mobile no: 8308194315 Telephone No. with STD code:
Aadhar Card No:337707349503 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Augusta Cardozo Relationship with candidate: Mother
Parents Date of Birth: 10 Jul 1971 Parent's/Guardian's Occupation/Designation: Housewife
Office Address:
Address: Colleavaddo, Assolna Salcete Goa
Country: India State: Goa
City/District: South Goa Pin: 403701
Tel: Mobile no.: 9850255885
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Goa Board: Goa
School: Regina Martyrum High School School: Shree Damodar Higher Secondary School of Science
City: Assolna City: Margao
English %: 77 Board Roll No./Seat No.:
Aggregate Percentage: 86 School/College Code:
  Centre code:
  Address of School/College: Comba, Margao
  Pin: 403601
  Contact Nos:
  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
08/2016 Spelling Competition School Second
How do you intend spending your time after completing class XII Final exams and before joining college ?: I would like to enrich my knowledge in computer systems
Why do you wish to join TMI?: Because it is the best maritime institute for pre sea courses in India with maximum knowledge and training .
What are your hobbies?: Playing Football, Fishing
What are your strengths?: I have attitude of responsibility ,self control and i am a quick learner
What are your weaknesses?: I am a bit shy person
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 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 ________________

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