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: DNS2179177 Name: debashish das
  Address: a/49, koelnagar a/49 koelnagar
Telephone No.: 09668271695 Mobile no: 9668271695
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 204.83 (Includes Convenience fee of ₹ 4.83 ) DD Number: -
Issuing Bank: - Transaction Id: 430186979
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2179177 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: DNS2179177
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: debashish das
Mother's Name: kalpana das
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 16 Oct 2001 Nationality: Hindu
Place of Birth: Rourkela Personal Identification Mark: small cut mark in the face
Blood Group: O + Address for Communication: a/49, koelnagar a/49 koelnagar
State: Orissa Country: India
Pin: 769014 City/District: Rourkela
Mobile no: 9668271695 Telephone No. with STD code: 09668271695
Aadhar Card No:483148646838 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: baishnab das Relationship with candidate: father
Parents Date of Birth: 28 Jun 1966 Parent's/Guardian's Occupation/Designation: buisness man
Office Address:
Address: s/36 nac market koelnagar s/36 nac market koelnagar
Country: India State: Orissa
City/District: sundergarh Pin: 769014
Tel: Mobile no.: 9437221695
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2018 Year of Passing: 2021
Board: CBSE Board: CBSE
School: deepika english medium school School: deepika english medium school
City: Rourkela City: Rourkela
English %: 83 Board Roll No./Seat No.:
Aggregate Percentage: 67 School/College Code:
  Centre code:
  Address of School/College: a/49, koelnagar
  Pin: 769014
  Contact Nos: 09668271695
  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
09/2018 NCC Cadet Cadet
How do you intend spending your time after completing class XII Final exams and before joining college ?: After completing XII exams i joined the Gym and try to get the best shape for my body and mind. I also joined swimming classes to learn swimming. Cars and bikes are my hobby and after i got some free time i try to better understand them and explore new places while learning a everything about the vehicle i am driving.
Why do you wish to join TMI?: I have a urge to explore and learn new experience. I have researched and i found out it is a really good academy which will help me to excel with my career and have my dream come true.
What are your hobbies?: Gym, Cars , Bikes, cooking, playing chess
What are your strengths?: risk taker, workoholic, quick learner, Focused, Taking initiative
What are your weaknesses?: Insecure, Too detailing, Public speaking,
How do you intend to meet the expenses of this program?: Bank Loan
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 ________________

Print Summary and Application Form