APPLICATION FORM
PGDM 2017-2019
Programme Applied for
Full Name (As Per Class X Marksheet)
Gender Male Female
Date of Birth (DD-MM-YYYY)
Category Open OBC SC ST PH VH NT-DT Other
Religion
Address
E-mail ID
Correspondence postal address (IN CAPITALS) (Do not repeat name)
Mobile/Tel No.
 
FAMILY DETAILS
 
   
Father's/Husband's Name
Mother's Name
Profession/ Business
Designation
Name of Organisation
Office Address
Office Tel No.
Are you an NRI? Yes     No    
Are you currently employed? Yes     No   
Name and address of the Organization
Your Designation Total Experience (No. of Yrs.)
Do you require hostel accommodation? Yes    No
 
ACACADEMIC QUALIFICATION (Xth Standard Onwards)
 
Examination/Course (Mention Stream of Study)
Year of Passing
School/College Attended
Board/ University/institution
% of marks obtained/grade
Area of Specialization / Subjects
Class X
     
Class XII
         
Graduation
         
Any other
         
Special Achievements (If Any)
Extra Curricular Activities/Hobbies
Admission Test:
CAT     MAT     XAT ATMA   CMAT    
Percentile: CAT    MAT    XAT   ATMA   CMAT


Attach photocopies of the following certificate and tick the appropriate boxes

Class X Marks Sheet   Class XII Marksheet  Graduation Marksheet Entrance Test Score Card
Work Experience Certificate if any   Registration Fee   Any other
 
DECLARATION BY APPLICANT
 
I,  the undersigned, affirm that the information furnished above is correct to the best of my knowledge and belief, and that I will accept as final and binding, the decision of “ACCMAN INSTITUTE OF MANAGEMENT” regarding my admission . If any information provided by me is found to be false or incorrect at a later date, I will be held solely responsible for the legal and other consequences. I hold my self-responsible for the dues and prompt payment of fees, if selected. I have noted that fees once paid are not refundable, under any circumstances.
Place: Name:
Date:    
 
DECLARATION BY GUARDIAN / PARENT
I hereby vouch for what has been stated above my son/daughter/ ward in respect of his/her enrolment at the Accman Institute of Management.
Place: Name:
Date: