Application Form

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Application Form
(To be filled by the candidate (his or her) own handwriting, Use Capital Letters)
Date Received: Application No: 1. Candidate's full name (as per SSC Memo) 2. Address Identity No:

Affix latest passport size Photograph duly attested by a Gazetted Officer or Principal of the institute last studied

Pin code 3. Father's / Guardian’s Name (as per SSC Memo) 4. Mother's Name in Capital Letters

5. Date of Birth (as per SSC Memo) D 6. Nationality: 7. Identification Marks 1. 2. 8. Category applying for CONVENOR (CET) SEATS 9. CAT/MAT/XAT/ATMA Entrance Rank: Hall Ticket No. 10. Annual Income of Parent/Guardian: 11. Occupation of Father if employed; Telephone No.: (O) Email ID: Occupation of Mother if employed; Telephone No.: (O) Email ID: (R) (R) Religion: D M M Y Y Y Y

Sex: Male

Female

Category (OC/SC/ST/BC) Branch Opted:

MANAGEMENT SEATS

(Put tick in the appropriate box)

Department: Mobile No.:

Designation

Department: Mobile No.:

Designation:

12. Student E-mail ID 13. Address for Correspondence (any change intimated immediately)

Pin: E-mail

Telephone

14. Permanent Home Address:

Pin: E-mail

Telephone No

15 (A) Contact Person (Other than Parents) Local Guardian: For contact reference purpose (furnish full Address) 1. Name: Position: Address: 2. Name: Position: Address:

Phone: Email: Phone: 16. Educational Qualifications: Exam Passed Degree 10+2 SSC/ Equivalent 17. Extra Curricular Activities, Sports/NCC/NSS etc. University/College/ School Year of Passing

Phone: Email: Phone:

Marks Obtained

%of Marks

Distinction Award

18. Have you ever been precluded from study at this B-School or any other higher education institution? Yes If yes, please give details: No

19. Other relevant programs of Training or Study undertaken.

20. Relevant employment experience (if preferred curriculum viate can be attached) Employer Position Nature of job Experience Date From Date To Full/Part Time... [continues]

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