Admission form for all the programmes under Distance Mode.

The date of entrance examination for MBA is fixed on 19

th
August 2010
between 11 AM to 12:30 & arranged at respective study centres.
Last date for submitting Admission form & exam fee of Rs. 300/- in
favour of Finance & Account officer SRTM University, Nanded is 18
th
August
2010.
Application No.
SWAMI RAMANAND TEERTH MARATHWADA UNIVERSITY, NANDED
APPLICATION FORM
ADMISSION
DO NOT
Staple
Affix your latest
passport size
photograph (4cmx5cm)
duly attested by you
Enrolment No.:
(for office use only)
Regional Centre Code : Study Centre Code:
1. Name of the Student ( in Block letters) : ______________________________________________
a) Fathers Name:__________________________________________________________________
b) Mothers Name:__________________________________________________________________
a) Phone No. Code No.
b) Mobile No. c) E-mail: ____________________________
2. Complete Address ( in Block letters) :________________________________________________
_______________________________________________________________________________
3. Details of fee paid : As per the course opted, the draft for Rs.______________________________
in words Rs .___________________________________________________ drawn in the name of
Finance & Account Officer, SRTMU, Nanded payable at Nanded.
a. Name of the Bank:________________________________________________________________
b. Bank Draft No.:__________________________________________________________________
c. Total Amount Rs._________________________________________________________________
4. Educational Qualification:____________________________________________________________
(attach copies of the mark sheet and certificate)_________________________________________
5. Date of Birth : Date Month Year
6. Gender : Male Female
7. Name of the course opted: _____________________________________
8. Academic Year : 20.. to 20.
Please Page No. 2
Please ( ) the appropriate box only
9. Medium : English Hindi Marathi
10. Marital Status : Married Unmarried
11. Nationality : Indian Other If other, please specify :_________
12. Category : SC ST OBC NT
VJNT Other SBC
13. Location : Urban Rural Tribal
14. Religion : Hindu Muslim Christian
Sikh Jain Buddhist
Parsi Jews Other
DECLARATION BY APPLICANT
I hereby, declare that I have read and understood the conditions of eligibility for the programme for
which I seek admission. I fulfil the minimum eligibility criteria and I have provided necessary information
in this regard. In the event of any information being found incorrect or misleading, my candidature shall be
liable to cancellation by the University at any time and I shall not be entitled to refund of any fee paid by me
to the University.
Signature of the Student
Name :
Date:______________
Checklist
Affix photograph and sign over it, Attach the following.
i. Demand Draft towards Programme fee.
ii. Certificates in support of your Educational Qualification (s)
iii. Category Certificate for SC/ST/OBC/PH candidate wherever required
iv. Age certificate wherever required or Transfur Certificate