Post Graduate Diploma in Business Analytics (PGDBA)

Application Form

Name: _____________________________________________________________________
(In CAPITAL LETTERS, as recorded in your school leaving certificate)
Date of Birth:
DD

MM

Category (): General

Please affix
your recent
passport size
photograph

Gender (): Male

Female

DA#

(If NC-OBC, SC, ST or DA, attach

necessary certificates)

YY
SC

ST

NC-OBC

If NC-OBC, mention name of the Caste/Sub-Caste/Community

State

Entry No.^

Marital Status (): Single

Married

(Please follow: http://ncbc.nic.in/backward-classes/index.html)

Nationality (): Indian

Others

Mailing Address:
City:
Landline No.:

Pin/Zip code:

Mobile No:

E-mail ID:
Guardians Name: _______________________________________________ Relationship: ________________
Fathers Name: ___________________________________ Mothers Name: ___________________________
Relation

Education

Occupation

Designation

Annual Income (Rs.)

Father
Mother
Annual Income of Family including the Applicant*(Rs.): _______________________ Financial Year 2014-2015
Annual Income of the Applicant*(Rs.): ____________________________________ Financial Year 2014-2015
Application Fee Details for candidates:
Application Fee:

Rs.1500/-for General and NC-OBC)

Demand Draft (D.D.)/Bankers Cheque/Pay Order No:

Rs.750/- for Female/SC/ST/PWD(DA)

Date:

Bank Name:
________________________________________________________________________________________
# Differently Abled
^ Central List of NC-OBC by the National Commission of Backward Classes, GoI as on last day of application will be used. Any
subsequent changes will not be effective for this year admission process. Please fill-in the Entry No. & Caste/Sub- Castes/
Communities Boxes above.
* Applicants income should include variable and fixed income if employed. Please ensure the validity of self and family income
statements as they may be subject to verification for internal administration.

Qualifying Examination/Academic Details

(Please attach self-attested copies of the transcript)

Qualifying Examination

Validity of Score

Common Admission Test (CAT)

CAT 2014 held in November 2014

Graduate Management Admission Test (GMAT)

Score not earlier than 2 years from April 17, 2015

Graduate Record Examinations (GRE)

Score not earlier than 2 years from April 17, 2015

Graduate Aptitude Test in Engineering (GATE)

Score not earlier than 2 years from April 17, 2015

Indian Statistical Institute (ISI): Qualified for any

Masters level entrance examination

Qualified not earlier than 3 years from April 17, 2015

Pre-Bachelor Degree Examination Details: (Please attach self-attested copies of the transcript)
Stream during classes 11 12:
Class

Name of the School

Board

Year of
Passing

Marks
Obtained

Total Maximum
Marks

Division

10th
12th
Bachelors Degree Examination Details: (Please attach self-attested copies of the transcript)
Discipline (): Arts

Commerce

Engineering

Science

Others

If Others, please specify:

Specialization in Bachelors Degree:
Degree

Name of College/
Institute & University

Total

Duration of Degree Course:

Year
From
To

Total Maximum
Marks/CGPA

Total Marks/
CGPA Obtained

Class

If incomplete, please mention the expected date of completion of final examination including practical/viva/assignments/
projects: ________________

Masters Degree Examination Details: (Please attach self-attested copies of the transcript)
Discipline (): Arts

Commerce

Engineering

Science

Others

If Others, please specify:

Specialization in Masters Degree:
Degree

Name of College/
Institute & University

Total

Duration of Degree Course:

Year
From
To

Total Maximum
Marks/CGPA

Total Marks/
CGPA Obtained

Class

If incomplete, please mention the expected date of completion of final examination including practical/viva/assignments/
projects: ________________

Other Professional Degree/Diploma (if completed): __________________________________

DESIGNATION

JOB PROFILE

DURATION TOTAL SALARY

(PER MONTH)
Months
Days

REASONS FOR LEAVING

Total Work Experience as on April 17, 2015: ______________________________ (in months & days).

ORGANISATION

Do not include training/project work/work done as an integral part of curricular requirement. State work experience after Graduation only. Attach copies of
experience certificates or first & last pay slips. In case you are self-employed or employed in a family business or in a company not listed in NSE or BSE, attach
a note detailing the business (including turnover and profit) and the nature of your experience.

WORK EXPERIENCE: (Upto April 17, 2015 in chronological order. Please attach a separate sheet if required)

Extra-Curricular Activities in College/University:

Nature of Activity

Honours/Award & Prizes, if any

Extra Curricular Activities at District/State/National Level:

Nature of Activity

Level*

Honours/Award & Prizes, if any

* Mention District/State/National Level

List out your hobbies (not more than two) with brief description:
1.

2.

Career Goals: (Do not write more than 100 words):

Academic Distinctions/Prizes/Awards/any other useful information:

Sl. No.

Title

Level*

Year

1
2
3
4
5
* Mention District/State/National Level
Preferred Interview City: Bengaluru

Delhi/NCR

Hyderabad

Kolkata

Mumbai

DECLARATION:
I declare that the information given by me in this application form is true and complete in all
respects to the best of my knowledge. I understand that suppression of facts or false
information may lead to rejection of my application at any stage of the selection process. I also
understand that the decision of IIM Calcutta in any matter related to the selection process is
final and binding upon me.
_______________________
Place

______________________
Date

________________________
Signature of Applicant

INSTRUCTIONS
1.

This Application Form duly filled-in must be sent to In-charge, Admissions Office, Indian
Institute of Management Calcutta, Joka, Diamond Harbour Road, Kolkata 700 104 on before
April 17, 2015.

2.

You need to bring at least one acceptable form of photo-identification. Acceptable forms of
valid photo identification are valid Drivers license, Passport, PAN Card, Voter ID, Employee
identification card, or a notarized Affidavit with Photo, Signature, Date of Birth and Residential
Address.

3.

Please affix a self attested recent passport size photograph.

4.

NC-OBC/SC/ST candidates are required to submit a certificate duly signed by the competent
authority along with the application form. Candidates are also required to bring the original
certificate for verification at the time of interview. Only certificates issued by competent
authorities designated by the State/UT/Central Government will be considered.

5.

Differently Abled (DA) candidates are required to submit a certificate duly signed by the
competent authority as per the Persons with Disability (PWD) Act 1995. Candidates are also
required to bring the original certificate for verification at the time of interview.

6.

Please ensure the correctness of the self and family income statements as they may be
subject to verification for internal administration.

7.

All the original academic certificates/mark-sheets must be produced at the time of interview
for verification.

8.

Please bring self-attested copies of all mark-sheets and certificates.

9.

Necessary evidence (Certified record of experience or first and last pay slips) in support of
work experience must be attached along with the application form and the original documents
must be produced at the time of interview. Please note that Appointment Letter will not
be considered as joining date in lieu of first salary slip. If evidence of work
experience is not produced during the interview, the work experience will be
taken as NIL.

10.

Necessary evidence must be produced in support of extra curricular activities at the time of
interview.

11.

Wherever letter/point grades are used, corresponding percentage equivalents should be

provided. A certificate from the relevant University/Institute must be enclosed indicating the
conversion formula. If such a conversion is not possible, mention it below the marks columns
and enclose a certificate from the relevant University/Institute to that effect.

12.

This Application Form and proforma of certificates can also be downloaded from IIM Calcutta
website www.iimcal.ac.in