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

APPLICATION FOR ADMISSION - 2021

 
  Dossier ID:
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: Priyanshu Chourasia
Mother's Name: Biva Kumari
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 19 Apr 2004 Nationality: Indian
Place of Birth: Darbhanga Personal Identification Mark: Black mark in right eye and cut at forehead
Blood Group: B + Address for Communication: Ps Keoti . Po S lalganj Vill Gathulli ward 4
State: Bihar Country: India
Pin: 847121 City/District: Darbhanga
Mobile no: 8987378102 Telephone No. with STD code:
Aadhar Card No:890178252914 E-mail: playorrbrow4195@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: Biva Kumari Relationship with candidate: Mother
Parents Date of Birth: 05 Feb 1978 Parent's/Guardian's Occupation/Designation: Teaching
   
Office Address:
   
Address: Ps Keoti Vill Dumari dighiyar tole
Country: India State: Bihar
City/District: Darbhanga Pin: 847121
Tel: Mobile no.: 9430578535
Fax: Email: bivakumari2266@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: CBSE
School: 50218-DON BOSCO SCHOOL BIBI PAKAR LALBAGH DARBHANGA BR School: Don Bosco School Darbhanga Br
City: Darbhanga City: Darbhanga
English %: 78 Board Roll No./Seat No.:
Aggregate Percentage: 86 School/College Code:
  Centre code:
  Address of School/College: Bibi Pakar Darbhanga 846004
  Pin: 846004
  Contact Nos: 7547877802
  Email: dbs_dbg@yahoo.in
  Aggregate Percentage:
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
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
MONTH / YEAR (MM/YYYY) SPORT/ACTIVITY LEVEL OF PARTICIPATION POSITION
02/2016 Cricket Captain 1
04/2017 Cricket 2nd man 3
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: Studying
Why do you wish to join TMI?: I just want to go to sea
What are your hobbies?: Cycling
What are your strengths?: My Intelligence and education
What are your weaknesses?: Emotion
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
 
Declaration

I hereby declare that all the statements made above are true and correct.

Signature of Candidate

 

___________________

Date ________________

 
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