APPLICATION FORM-2015 MASTER OF BUSINESS ADMINISTRATION (FULL-TIME)

*Form No:
APPLICATION FORM-2015
MASTER OF BUSINESS ADMINISTRATION (FULL-TIME)
----------------------------------------------------------------------------------------------------------------------------------------------------------------------Instructions
1. This form is an integral part of the admission process. Please provide correct information.
Admission granted on incorrect information will be ipso facto null and void.
2. Fill in the application form legibly. Incomplete forms shall not be considered.
Applicants
3. All applicants are required to appear for the Common Admission Test (CAT-2014) conducted by the
Photograph
Indian Institutes of Management (IIM).
4. This form should be sent only after you have received the CAT Admit card. An application form
which does not indicate valid CAT Registration No. will not be considered.
5. Do not attach any certificates and mark sheets or their copies to this form for the general category
6. In all matters regarding admission to the programme, the decision of the University will be final
and binding on the applicant. No correspondence from the applicant with respect to his/her non-selection will be
entertained. The admission process at the University shall be subject to the jurisdiction of the courts of Ahmedabad.
7. *Form no. will be assigned by the Admissions office and the detail will be emailed to you.
8. Enclose a draft for Rs. 1,500/- drawn in favour of “Institute of Management, Nirma University” payable at Ahmedabad
9. The Admission process is subject to the conditions prescribed by the Government of Gujarat from time to time
Demand
Draft
Details
Bank Name
Demand Draft No
Demand Draft Date
CAT Registration No.
(Please attach photocopy of CAT Admit card)
A.
PERSONAL DETAILS
Name (Block Letters): _________________________________________________________________________________
First Name
Middle Name
Surname
Address (For Correspondence):
__________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
City :__________________________________ Pin ____________________
State : ____________________________
Telephone __________________________________________ Mobile________________________________________
E-mail (Block Letters) (1)______________________________________________________________________________
(2)______________________________________________________________________________
Gender
:
Date of Birth:
Male [ ]
Female [ ]
Date _____ Month _______ Year ______
Blood Group:__________________________________
Age (as on May 31, 2015): _____ years
Nationality:_____________________________ Caste (GEN/OBC/ST/SC):_______________________________________
Father’s/ Guardian’s Name: __________________________________________________________________________
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B.
EDUCATION
1.
School Education
Particular
S.S.C (X)
H.S.C (XII)
Board Name
Stream (Science / Commerce)
Medium of Instruction
Aggregate (%)
Year of Passing
Pass Attempt
2.
First(
)
Other( ) (Please Tick )
First(
Other( ) (Please Tick )
)
College Education
Have you completed your Bachelor’s Degree?
Yes [
]
No [
]
Name of the Graduation Degree
(Please mention the name of Degree
such as B.Sc., B.Tech, B.com etc.)
Stream (Science, Commerce,
Arts, Mechanical, Electrical etc..)
Mode of Study
(Please Tick )
Full Time \ Distance \ Other
University Name
Medium of Instruction
English \ Other
(Please Tick)
Year of Admission
Year of Passing
Aggregate Percentage
Have you passed all examinations in single attempt?
Yes
(
)
No
(
) (Please Tick )
(Students who have passed all examinations (course-wise) in the first attempt only should indicate passing attempt as “First”)
Note : Final year students should indicate percentage of aggregate marks obtained in all the previous examinations.
C.
Sr. No.
WORK EXPERIENCE (ONLY FULL-TIME JOB AFTER GRADUATION IN A PROFESSIONAL ORGANIZATION)
Organisation
Position
From
Period (in months)
To
Total Number of Months
2
Total
D.
CHOICE OF INTERVIEW CENTRE (IF SHORT-LISTED):
Please mark clearly only one centre
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Ahmedabad
( )
2
Bangalore
( )
4
New Delhi
( )
5
Pune
( )
3
Kolkata
( )
The University reserves the right to cancel any of the centre at its discretion.
E.
ARE YOU APPLYING IN THE CATEGORY OF FOREIGN NATIONALS/PERSONS OF INDIAN ORIGIN
(PIO)/NON RESIDENT INDIANS (NRI) /NRI SPONSORED / CHILDREN OF INDIAN WORKERS OF
GULF COUNTRIES AND SOUTH EAST ASIA?
Yes [ ]
No [ ]
If yes, please tick in the appropriate box (√) below and enclose a bank draft for US $ 115 or Rs.5,000/- drawn in
favour of “Institute of Management, Nirma University” payable at Ahmedabad as processing fee. Candidates having
already paid Rs.1500/- or US$ 35 for the application fee are required to pay only Rs. 3500/- or US$ 80.
1.
3.
5.
*Foreign National
*Non Resident Indian
*Gulf Quota
(
(
(
)
)
)
2.
4.
*Person of Indian Origin (
**NRI Sponsored
(
)
)
Bank Details
D.D. No : ____________________ Bank Name : __________________________ Date : ______________________
Note :
* Candidates applying in a particular category are required to enclose the document verifying their status to be
eligible for consideration in that category.
* Candidates applying through GMAT need to submit their GMAT score latest by February 28, 2015.
** Only Candidates appearing for CAT-2014 are eligible to apply under NRI Sponsored Category.
F.
DECLARATION:
I have carefully read the instructions and agree to abide by the decision of the University regarding my selection to
the programme. I certify that the information furnished in this application form is correct to the best of my
knowledge and belief.
Place: ___________________
Signature of the Applicant
Date: ___________________
All communication with regard to admission will be online or through electronic mails and therefore the candidates
are advised to keep track of the online information at our website (nirmauni.ac.in/im) and their email provided to us
during the Admission-2015 process period.
The completed application form should be submitted to the Deputy Registrar, Institute of Management,
Nirma University, S.G. Highway, P.O. Chharodi, Ahmedabad-382481, Gujarat latest by December 15, 2014.
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