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 2021)


Application Summary: Diploma in Nautical Science
 
Dossier ID: DNS2183624 Name: AGNIVESH R
  Address: ANTHICHIRA HOUSE POTHANPADAM MUTHALAMADA
Telephone No.: Mobile no: 8848401094
E-mail: pappaamma00@gmail.com  
   
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 282.6 (Includes Convenience fee of ₹ 82.6 ) DD Number: -
Issuing Bank: - Transaction Id: 434565269
   
   
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2183624 are true and correct.
Signature of Candidate Signature of Parent/Guardian
   
   

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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: info@tmi.tolani.edu, Web: www.tolani.edu
(New Admission Diploma in Nautical Science )

APPLICATION FOR ADMISSION - 2021

 
  Dossier ID: DNS2183624
 
Applicant's Personal Information:
 
Full Name as on Class XII Marksheet/Pass Certificate: AGNIVESH R
Mother's Name: BIJILI B
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 01 Mar 2004 Nationality: INDIAN
Place of Birth: PALAKKAD Personal Identification Mark: WOUNDED STITCHED SCAR ON BACK OF THE HEAD
Blood Group: A + Address for Communication: ANTHICHIRA HOUSE POTHANPADAM MUTHALAMADA
State: Kerala Country: India
Pin: 678507 City/District: PALAKKAD
Mobile no: 8848401094 Telephone No. with STD code:
Aadhar Card No:569111612785 E-mail: pappaamma00@gmail.com
 
Guardian's Particulars:
 
Name of Parent/Guardian: K RAMESH Relationship with candidate: FATHER
Parents Date of Birth: 04 Apr 1970 Parent's/Guardian's Occupation/Designation: KSEB CONTRACTOR
   
Office Address:
   
Address: ANTHICHIRA HOUSE POTHANPADAM MUTHALAMADA
Country: India State: Kerala
City/District: PALAKKAD Pin: 678507
Tel: Mobile no.: 9447075686
Fax: Email: rameshandhichira@gmail.com
 

Education and Academic Record :


Class X: - Class XII: -
Year of Passing: 2019 Year of Passing: 2021
Board: CBSE Board: Kerala
School: VYASA VIDYA PEETHOM School: VELAYUDHAN MEMORIAL HIGHER SECONDARY SCHOOL
City: PALAKKAD City: PALAKKAD
English %: 66 Board Roll No./Seat No.:
Aggregate Percentage: 55 School/College Code:
  Centre code:
  Address of School/College: VADAVANNUR
  Pin: 678504
  Contact Nos:
  Email: vmhss@gmail.com
  Aggregate Percentage:
   
Details of Marks Secured in (10+2) Examination -

SUBJECTS MAXIMUM MARKS
MARKS SECURED PERCENTAGE (%)
Physics 200
Chemistry 200
Mathematics 200
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
07/2016 FOOTBALL BVN STATE FIRST
 
How do you intend spending your time after completing class XII Final exams and before joining college ?: STUDYING FOR COMPETITIVE EXAMS
Why do you wish to join TMI?: FAMOUS INSTITUTION
What are your hobbies?: SPORTS AND DANCE
What are your strengths?: COURAGE
What are your weaknesses?: FINANCIAL
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
 
Declaration

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

Signature of Candidate

 

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Date ________________

 
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