Note:
Please read the form carefully before filling it.
Attach the required documents as mentioned in educational qualification.
Result/Score of qualifying examination.
Incomplete application will be rejected.
Form No
Registration No
(To be given by the office)
Programme Applied For :
*
Programme
PGPRM + MBA
PGPIB + MBA
PGPI + MBA
PGPHTM + MBA
PGPIT + MCA (Integrated)
PGPIT + MCA
Campus Option :
*
--Select Campus--
Lajpat Nagar
Rohini
Vasant Kunj
Vikaspuri
Personal Details:
Name Mr./Ms.
*
( eg.Raj Kumar)
Date of Birth :
*
Day
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
(as in the certificate of 10th examination)
Age
yr
Nationality
Category
Category
GEN
OBC
SC
ST
Marital Status
Married
Unmarried
Gender
Male
Female
Contact Details:
Correspondence Address :
*
Phone No.:
Mobile No.:
Mail ID.:
Permanent Address :
*
Same as above:
Phone No.:
Mobile No.:
Detail of Local Guardian :
Name:
Phone/Mobile No. :
Address :
Family Details:
*
Parent's Name
Occupation
Phone No.
Mobile No.
Mail ID
Educational Qualifications:
*
Examination Passed
Name of The Stream
Name of the School/College and Board/University
Year of Passing
Subject Studied
Marks Obtained
Maximum Marks
% of Marks
10
th
*
12
th
*
Graduation
*
PG
Others
Details of the Qualifying examination:
*
Name of Qualifying Examination :
-Select-
CATA
MAT
NAT
ATMA
Other
Exam Date
Score
Roll No
Awards and Achievements (if any)
:
Participation in Extracurricular Activities :
Employment History :
Work Experience:
Yes
No
(If, Yes )
Total Experience :
Years
Organization / Company Detail :
Name of Company
Address
Duration
Designation
Nature of Work
Salary Drawn
Payment Mode :
Demand Draft Pay Online
DD No.
DD Date
Amount
Name & Address of Bank
Declaration:
I hereby certify that the information given in the Application is complete and accurate to the best of my knowledge. I understand and agree that misrepresentation or omission of facts will justify the denial of admission, cancellation of admission or expulsion.
Date (mm/dd/yyyy)
*
Place
*
Note :: Kindly ensure that all the fields are filled correctly.