Xime Application File

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XIME APPLICATION NO 182012

XAVIER INSTITUTE OF MANAGEMENT & ENTREPRENEURSHIP

Fax: 080-2852 0809 E-mail : admissions@xime.org Website: www.xime.org

APPLICATION FOR TWO-YEAR PGDM PROGRAMME

1. (a) XAT ID (2012)

(b) CAT Registration No. (2011)

(c) XAT Score inpercentile (2012)

(d) CAT Score in percentile (2011) - in lieu of XAT

2. Preferred GD/Interview Centre Bangalore Chennai Hyderabad Kochi

(Please circle)

3. Name(incapitallettersasinDegreeCertificate/MarkSheet)

Date of birth MM YYAge as on 1/7/2011DD

Gender Marital status Married UnmarriedM/F

Candidatestoaffix passport size photograph Religion Mother tongueand sign across

Category SC ST BC OBC Others
(Tick)

Nationality NRI Yes No

Details of Parents Father Mother

Name

Occupation / Current Job

4. Mailing Address with PINPermanent Address with PIN

Contact : Tel No. (with STD code) : Tel No. (with STD code):

Email address :

Mobile No.
5. Languagesknown(otherthanEnglish):

LanguageReadWriteSpeak

6. Academic Record

Year Name of School, Major Total Max.
Marks Qualification
%
(Aggregate) From - ToBoard, College SubjectsMarks
University & PlaceobtainedMarks

Std X

Std XII / PUC

Degree B.A. / B.Sc/
B.Com./B.Tech.

one applicable)
(P
Others (specify)

P.G. Degree
(specify)

Other Recognized
Course(of duration
1 year or more)

** Applicants are required to have a bachelor’s degree from a recognized university with a minium aggregateof50%forallsubjectstakentogether(45%forSC/STcandidates)

7. Awards,Scholarships,andSignificantAchievements(Bespecific)

LevelAcademicsSports / GamesCultural Events

School Level
(upto 2nd position)

College Level
(upto 2nd position)

University / State Level
(upto 10th position)

National level
(upto 20th position)

NCC / NSS ParticipationYes No

If Yes, give details
8. ListWorkExperiences(ofdurationatleast6months)

Date
OrganizationDesignationAnnual SalaryReasons for Leaving
FromTo

Describethenatureofworkandresponsibilitiesassociatedwithyourmostrecentjob

9. ExplainwhyyouhavechosentostudyatXIME.

10.HowdidyoucometoknowaboutXIME?(pleaseP)

NewspaperMagazineCoaching centreOther sources (specify)

websiteXIME StudentAlumniXIME

11. Have you ever applied to XIME before ? Yes No

If Yes, mention year

CARDXIME APPLICATION NO 18INTERVIEW

Ifyouarefoundeligible,youwillbesentaninterviewcard.Pleasewritewithintheboxbelow your name and mailing address, where you want the interview card to be sent.

Please write in capital letters

E-mail address :
Declaration

I hereby declare that the particulars given in this application are true and correct and will be supportedbyoriginaldocumentswhenrequired.IconfirmthatIhavefullyreadthetermsand conditions regarding the admissiion to XIME’s PGDM programme and...
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