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: Sushma Rajesh Gaikwad
Mother's Name: Laxmi Rajesh Gaikwad
Gender (M/F): Female Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 10 Mar 2000 Nationality: Indian
Place of Birth: Adulse Personal Identification Mark: Mole on neck
Blood Group: A + Address for Communication: FLAT.NO-303, SHREE SAI BABA TOWER OPP. PANCHPAOLI POLICE STATION NEAR SANTH NIRANKARI SATHSANGH BHAVAN Dr. Ambedkar Marg S.O, Nagpur-17
State: Maharashtra Country: India
Pin: 440017 City/District: Nagpur
Mobile no: 7887510631 Telephone No. with STD code:
Aadhar Card No: E-mail: sushmagaikwad200003@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: Rajesh Sudhir Gaikwad Relationship with candidate: Father
Parents Date of Birth: 24 Feb 1969 Parent's/Guardian's Occupation/Designation: Private Job
   
Office Address:
   
Address: ANKUSH SHIKSHAN SANSTHA, CRPF GATE, NO.3, HINGNA ROAD, DIGDOH HILLS, NAGPUR , MAHARASHTRA,440017 CRPF GATE, NO.3, HINGNA ROAD DIGDOH HILLS, NAGPUR , MAHARASHTRA - 440016
Country: India State: Maharashtra
City/District: Nagpur Pin: 440016
Tel: Mobile no.: 9860327791
Fax: Email: rajeshgaikwad1969@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2016 Year of Passing: 2018
Board: CBSE Board: Maharashtra
School: St.Xaviers High School School: Dada Ramchand Bakhru Sindhu Mahavidyalaya
City: Nagpur City: Nagpur
English %: 76 Board Roll No./Seat No.: N024262
Aggregate Percentage: 68 School/College Code: 006
  Centre code: 0321
  Address of School/College: Kaka Tilokchand Rughwani Marg, Panchpaoli, Nagpur
  Pin: 440017
  Contact Nos:
  Email: principalsmvnagpur@yahoo.in
  Aggregate Percentage: 60
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 100 47 47
Chemistry 100 51 51
Mathematics 100 52 52
Physics, Chemistry & Mathematics combined Percentage: 50
English 100 62 62
   
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
 
Declaration

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

Signature of Candidate

 

___________________

Date ________________

 
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