NATIONAL INSTITUTE OF BANK MANAGEMENT

NIBM Post Office, Kondhwe Khurd, Pune 411 048 Tel : 020-26716000 (EPABX) Fax : 020-26834478 e-mail : pgdm@nibmindia.org Website : www.nibmindia.org

APPLICATION FORM POST GRADUATE DIPLOMA IN MANAGEMENT (BANKING & FINANCIAL SERVICES)
(Session Beginning 2014) AICTE Recognized Please read the instructions (given on the back of this form) carefully before filling-up this application form.

Affix Photograph of 4 cms x 3.5 cms

A.

Personal Information First Name (Mr/Ms.) Middle Name Last Name

Date of Birth DD Please tick mark () Female MM Male

9 YY Married Single

Please tick mark () Whether you belong to SC/ST/OBC/Others SC Fathers Name Occupation Telephone No. E-mail Mobile No. Mailing Address House No./Area/ Locality/Street/ City State Pin Code STD Code & Tel. No. E-mail Mobile Alternate E-mail
1

ST

OBC

Others

: : : : :

B.

Qualifying Examinations As it appears in your CAT voucher/ATMA registration form/CMAT voucher Examination CAT 2013 ATMA (Feb. 16, 2014 only) CMAT 2014-15
(Please attach a photo copy of the admit card of CAT/ATMA/CMAT. Score card may be enclosed if result is declared)

Registration No.

Percentile/Score/Rank

Valid Till mm/yy

C.

NEFT/Demand Draft Details Remitters Name: (Please attach scan copy of the NEFT). Name of the Bank DD No. DD Date UTR No. Date of Remittance

D. Preferred PGPBF Interview Centres, viz. Pune/Mumbai/Delhi/Kolkata/Bengaluru/Lucknow (Centres other than Pune are tentative) First Preference Second Preference E. Academic Qualifications Qualification Name of the Institution/ Professional Body State/UT Name of the Board/ University Year of Completion* Marks (%)/CGPA (max/obtained)

Secondary School (X) Sr. Secondary School (XII) Graduate Degree with Stream Marks (%)/CGPA (max/obtained) Semester 1 Semester 2 Semester 3 Semester 4 Post-Graduate Degree with Stream Marks (%)/CGPA (max/obtained) Semester 1 Semester 2 Professional Degrees/ Diploma/ Certificate 1. 2. 3. 4. Semester 3 Semester 4 Marks (%)/CGPA (max/obtained) Semester 5 Semester 6 Semester 7 Semester 8 Marks (%)/CGPA (max/obtained)

* (Please mention final year of completion only. Otherwise write appearing)

F.

Work Experience [Furnish details of jobs starting with latest/current job first] Organization Name Designation Nature of Duties Designation of Last Person Reporting to Experience in Years & Months

G.

Academic/Professional Awards/Medals/Prizes/Scholarships/Certificates/Honours, etc (Excluding those for extra-curricular activities) Name of the Award Awarding Institution Level Basis of Award Year

H.

Major Extra-Curricular Activities/Hobbies at School/College/University Activity Role Level Year From To Honours, if any Remarks

1. 2. 3. 4.

I.

Declaration All entries made in this application form are true to the best of my knowledge and belief. I am willing to produce original certificates in support thereof if asked to do so at any stage. Admission can be cancelled at any stage, if any information given is found to be incorrect. Place ______________________________ Date _______________________________

Signature (Please see overleaf for Instructions for Filling the Application Form)
3

Instructions for Filling the Application Form

(a) Fill in the application form in CAPITAL letters with pen. Complete all items relevant to you. Incomplete applications will be rejected. Any mistakes and/or loss on account of wrong and/or illegible entries are the sole responsibility of the applicant. Mention your name (as it appears in the CAT/ATMA/CMAT voucher) and CAT/ATMA/CMAT Registration number in the NIBM Application Form. Please paste your photograph in the appropriate space provided, do not staple it. CAT/ATMA/CMAT applicant should make sure to enclose a photo copy of the CAT/ATMA/CMAT admit card with this application form. Candidates appearing for the final year bachelors degree/equivalent qualification examination and those who have completed degree requirement and are awaiting results must attach photocopy of the certificate from the Principal/Head of the Department/Registrar/Director of the University/Institution certifying that the candidate is currently in the final year/is awaiting final results and has obtained at least 50% marks or equivalent based on the latest available grades/marks. If admitted, admission of such candidates will be provisional and subject to their completion of all the eligibility requirements of the Programme mentioned in the prospectus. Please do not enclose any testimonials along with the form. All certificates (original) should be produced at the time of the interview. The filled-in application form should be accompanied with a payment of Rs 1250. The amount may preferably be transferred by RTGS/NEFT/ECS to our A/c No. 20002403044 with Bank of Maharashtra, NIBM branch, Pune (IFSC Code MAHB0001124). For all electronic remittances, kindly send a confirmatory e-mail at: pgdm@nibmindia.org giving details of the remitters name, UTR No., date of remittance and scan copy of the NEFT. In case, the amount is remitted by demand draft, it should be made in favour of 'National Institute of Bank Management', drawn on any Bank and payable at Pune. The remittence and the filled-in application form should reach The Dean (E) & Principal of the Institute before February 15, 2014. A copy of the Prospectus will be sent subsequently.

(b) (c) (d) (e)

(f) (g)

@@@@@@@@@@@@@@