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: Mohammad Ibrahim Kazi
Mother's Name: Nazmeen
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 24 Jan 2004 Nationality: Indian
Place of Birth: Pune Personal Identification Mark: Birth mark on left arm
Blood Group: A + Address for Communication: KASHANA 34A New Era Society Market Yard Pune 411037 KASHANA 34A New Era Society Market Yard.Pune 411037
State: Maharashtra Country: India
Pin: 411037 City/District: Pune city
Mobile no: 7758958465 Telephone No. with STD code: 02024268615
Aadhar Card No:999024272823 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Imtiaz Ahmed Kazi Relationship with candidate: Father
Parents Date of Birth: 22 Apr 1970 Parent's/Guardian's Occupation/Designation: Buisness
Office Address:
Address: KASHANA 34A New Era Society Market Yard Pune 411037 KASHANA 34A New Era Society Market Yard Pune 411037
Country: India State: Maharashtra
City/District: Pune city Pin: 411037
Tel: 02024268615 Mobile no.: 7758958465
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: Maharashtra Board: Maharashtra
School: St Vincents High School School: AKIs Poona College of Arts Science and Commerce
City: Pune city City: Pune
English %: 60 Board Roll No./Seat No.:
Aggregate Percentage: 71 School/College Code:
  Centre code:
  Address of School/College: KB Hidayatullah Road Camp Pune
  Pin: 411001
  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:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: Playing
Why do you wish to join TMI?: I have great interest
What are your hobbies?: Cricket
What are your strengths?: God
What are your weaknesses?: Devil
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 ________________

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