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APPLICATION FOR ADMISSION TO TWO YEAR FULL - TIME PGDM PROGRAMME 2010 - 2012

Name in Full(in block letters (as shown in certificate)	*
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Age	Date of Birth	Sex	Nationality	State	Community	Caste

(Attach copy of caste certificate in case of SC / ST candidate )

Father / Guardian’s Name	Occupation / Designation	Organisation

Permanent Address

Address for correspondence

Phone

Your local guardian / contact person in Kollam or nearest place

Name
Tel
Address
State relationship / acquaintance

ELIGIBILITY TEST DETAILS (CAT / MAT / XAT / ATMA)

Name of Test	Month & Year	Roll. No.	Composite Score	Remarks
*	*	*	*	*

Education(Attach True copies of all marksheets( optional ), orginals should be produced at the time of interview)

Course

Period
(Year)

Name of Examination passed and Board / University

Result (aggregate**)

Total Marks

Marks secured

%Marks secured

Plus II or Equivalent
Course
School

Main Subjects

Board/University

Graduation or Equivalent
Course		*
College		*

Main Subjects
	*
Board/University
	*

Post Graduation or Equivalent
Course
College

MainSubjects

Board/University

( Aggregate Marks include marks obtained for all parts of the examination (ie. part I, II and III or all Semesters) ( Marks obtained till date may be entered in case of candidates appearing for their final exams ) )

Upload Marksheets		( Max : 150 KB)
		( Max : 150 KB)
		( Max : 150 KB)
		( Max : 150 KB)
		( Max : 150 KB)

Details of Registration fees

DD No.	Amount	Date	Bank
*	*	*	*

Job Experience

Organisation	Designation	Period

Co-curricular activities

Type of activity	At School	At College	Elsewhere

Please explain briefly why you want to do a Management Course(Max: 100 words)

Any information regarding your strengths or aptitude or special interests which you would like us to consider for selecting you to the MBA Course(Max: 100 words)

I hereby declare that all the information provided in this form are true to the best of my knowledge. I understand that any misrepresentation by me in this application will disqualify my candidature at any point of time.
Date
Place

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