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Appln. No : PR.

No:

Hallmark Business School


Keelasaveriyarpuram , Aillithurai , Triuchirappalli – 620 102.
(Approved by AICTE and affiliated to Anna University Tiruchirappalli)

APPLICATION FORM - M.B.A DEGREE PROGRAMME

Year : ……………… Photograph :


Affix recent
Passport
size
photograph

1. Name of the Candidate : …………………………………………………………………………


(IN BLOCK LETTERS)

2. a) Mailing Address : ………………………………………………………………………….

………………………………………………………………………….

…………………………………………………………………………

Pin code : ………………………………

b) Phone number/Cell : ………………………………, ……………………………………….

C) e-mail ID : ………………………………, ……………………………………….

3. Gender : MALE / FEMALE

4. Date of Birth & Age : Date Month Year Age

5. Marital Status : …………………………………………………………………………

6 . Social Status : SC / ST / MBC / BC / DNC / OC

Nationality : …………………………………..

Religion : ………………………………….

Mother Tongue : ………………………………….


7. Particulars of Parent or Guardian*
( * Only in case parent is not alive ) : Father Mother

i) Name : …………………………………………………………………………..

ii) Occupation : …………………………………………………………........................

iii) Address : …………………………………………………………………………….


(Official)
…………………………………………………………………………….

…………………………………………………………………………….

Pin code : ………………………..

Phone number/Cell : ………………………………, …………………………….

8. Details of the qualified examination passed (Degree)

a) Name of the institution last studied :

b) Medium of Instruction :

Degree Reg .No Subjects Marks Class Name of the


(Specialization/Major) Secured University
(%)

Note: enclose photo copies of mark sheet, Degree (or) Provisional certificate and TC
TTCTCTC)
9. a) Proficiency in games and other :
extra – curricular activities
(enclose xerox copies of the certificate )

b) Hobbies, if any :

10. Mark and Registration Number


of TANCET/MAT Entrance Exam
(enclose photo copy) :

b) Marks Obtained :
11. Work Experience (if any)

S.No Organization Designation Period

HOSTEL ACCOMODATION

12. Hostel : Vegetarian / Non-Vegetarian

Signature of the Parent /Guardian Signature of the Applicant

Declaration

I do hereby declare that I fully satisfy the conditions with regard to eligibility and age as
stipulated by the Government of Tamilnadu. Also, I am fully aware that the admission is purely
provisional and subject to the approval by DOTE / Anna University Tiruchirappalli. Hallmark
Business School, Tiruchirappalli is not responsible for the rejection of my candidature by the
DOTE / University.

Signature of the Parent/Guardian Signature of the Applicant

Place :

Date :

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