Tolani Maritime Institute
Induri,Talegaon Dabhade, Pune - 410507
Tel.: 02114-669600/1, E-mail:, Web:
(New Admission Diploma in Nautical Science 2020)

Application Summary: Diploma in Nautical Science
Dossier ID: DNS2050029 Name: Ankit Kumar Mishra
  Address: Adarsh Nagar road no.3b Samastipur,Bihar
Telephone No.: Mobile no: 9199799044
Application fee payment details:  
Payment Status: Paid Payment Mode: Online
Amount: ₹ 200 (Includes Convenience fee of ₹ ) DD Number: -
Issuing Bank: - Transaction Id: 304977365
Declaration: We hereby declare that all the statements made in application form against Dossier ID DNS2050029 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 ensure that you send the following documents with your application.
  1. Write Application for Diploma in Nautical Science, Dossier ID on the envelope
  2. Print the application form duly filled
  3. Print the application summary duly signed where indicated
  4. Three identical recent passport size photographs with name & dossier id written at the back
  5. Self – attested copies of Class X marksheet and Pass Certificate
  6. Self – attested copies of Class XII marksheet and Pass Certificate (Candidates appearing for Class XII exam in 2020 may submit these copies after declaration of results)
  7. Self – attested copies of class XII marksheet downloaded from internet (Candidates appearing for Class XII exam in 2020 may submit these copies after declaration of results)
  8. Self – attested copies of school leaving certificate / transfer certificate (for proof of age)
  9. Self – attested copy of birth certificate (for proof of age and place of birth)
  10. Copies of sports and extra-curricular activities (Class VIII and above only)
  11. Copy of Class XII board exam admit card for those appearing in 2020
  12. A non-refundable Demand Draft of Rs. 200/- favouring “Tolani Maritime Institute” payable at Pune. Write your name, dossier id and contact details on the reverse of the Demand Draft (Kindly ignore if you have paid online)
  13. Please keep a copy of the form for your reference for communicating with the Institute

Send Duly filled application forms to:

Admissions Cell (DNS)
Tolani Maritime Institute
Talegaon-Chakan road, Induri,
Talegaon, Pune, Pin- 410507
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: DNS2050029
Applicant's Personal Information:
Full Name as on Class XII Marksheet/Pass Certificate: Ankit Kumar Mishra
Mother's Name: Brijwala Mishra
Gender (M/F): Male Marital Status (Single/Married): Single
Date of Birth (DD/MM/YY): 15 Jan 2002 Nationality: Indian
Place of Birth: Samastipur Personal Identification Mark: Mole on back of neck
Blood Group: B + Address for Communication: Adarsh Nagar road no.3b Samastipur,Bihar
State: Bihar Country: India
Pin: 848101 City/District: samastipur
Mobile no: 9199799044 Telephone No. with STD code:
Aadhar Card No:744643365302 E-mail:
Guardian's Particulars:
Name of Parent/Guardian: Deepak Mishra Relationship with candidate: Father
Parents Date of Birth: 15 Feb 1981 Parent's/Guardian's Occupation/Designation: Private job
Office Address:
Address: Saharsa road, maheskhunt Khagaria
Country: India State: Bihar
City/District: Khagaria Pin: 851213
Tel: Mobile no.: 9708689635
Fax: Email:

Education and Academic Record :

Class X: - Class XII: -
Year of Passing: 2017 Year of Passing: 2019
Board: CBSE Board: CBSE
School: Holy Mission High school School: D.A.V Public School
City: Samastipur City: Samastipur
English %: 85 Board Roll No./Seat No.: 7662656
Aggregate Percentage: 93 School/College Code: 50164
  Centre code: 7178
  Address of School/College: Harpur ailoth
  Pin: 848101
  Contact Nos:
  Aggregate Percentage: 70
Details of Marks Secured in (10+2) Examination -

Physics 100 62 62
Chemistry 100 74 74
Mathematics 100 58 58
Physics, Chemistry & Mathematics combined Percentage: 64.67
English 100 66 66
IMU CET Application Number:  
How do you intend spending your time after completing class XII Final exams and before joining college ?: Joining vocational course
Why do you wish to join TMI?: TMI is a prestigious institution which can definitely guide me to attain quality education in the relevant field, also hope to get placed after completion of course
What are your hobbies?: My hobbies are playing handball, volleyball and watching movies
What are your strengths?: My biggest strength is positive attitude towards accepting any thing which is right. Leading team, helping others , punctuality, hard work ,caring are other strength of mine . I love to have other suggestions
What are your weaknesses?: I am of very shy nature, at times I get sluggish,
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