Master of Business Administration (MBA) 2010-2013

Closing Date 15 march 2010 (3 Year, Part Time)

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Department of Management Studies

Hauz Khas, New Delhi 110016

Application Form

Please complete the form in block letters, without overwriting. Provide all the information required. Incomplete
forms will not be entertained.

1. Name of the Applicant:

First Name Middle Name Surname
In English
In Hindi

2. Date of Birth___________________ 3. Nationality__________________

4. Father’s Name_________________________________________________

5. Mother’s Name________________________________________________

6. Gender: Male / Female____________ 7. Category: Gen/OBC/SC/ST/PH______

8. Address Permanent: Current: (For Correspondence)

______________________ ____________________________
______________________ ____________________________
______________________ ____________________________
______________________ ____________________________
PIN___________________ PIN_________________________
e-mail_________________ e-mail_______________________
Mobile_________________ Mobile______________________

9. Academic record (in chronological order starting with most recent examination)

Examination Discipline/ University/ Board School/ College Year of % of

Passed Subject passing Aggregate
Marks or
CGPA

P.T.O.
Closing Date 15 march 2010

10. Detail of work experience, if any. (Start with most recent first):

Period Designation Organization Remark

11. Statement of Purpose: Please enclose a type written sheet starting your reasons for joining the
programme in about 150 Words.

12. Details of Demand Draft (Rs. 1000/- for general/OBC and for Rs. 500/- SC/ST/PH candidates) drawn
in favour of Registrar, IIT Delhi Payable at Delhi)
Number___________________________Date_____________________
Issuing Bank:______________________________

13. Declaration:

I certify that the information provided in this application is correct.

Application’s Signature____________________ Date______________________

Name__________________________________ Place_____________________

Note: Please send the completed form alongwith the Demand Draft to:

Deputy Registrar (PGS & R),

Indian Institute of Technology,
Hauz Khas, New Delhi- 110 015

FOR OFFICE USE ONLY

(Recommendation / observations of the office)

The candidate may be provisionally admitted / not admitted subject to the following:

1) Production of attested copies of the qualifying degree certificate and marks sheet shoeing the
required % of marks / CGPA by 22.07.2010 / 31.10.2010.
2) Production of proof from the University/ Head of the Institute of having appeared/ passed in the
qualifying Degree Examination by 22.07.2010.
3) Production of reliving certificate from Employer by 22 .07.2010.
4) Production of Attested copy of SC/ST/PH candidates.
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DR (PGS & R) Signature of OS (PGS & R)

 Closing Date 15 march 2010

Bring with you two copies of Admit Card at the time of Written Test at 9 am on 04 April 2010 at the
Exhibition Hall, IIT Delhi

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Department of Management Studies size photo
Hauz Khas, New Delhi 110016

ADMIT CARD
(Written Test for MBA-Part Time)

Name:
Address:

Candidate’s Signature Candidate’s Counter Sign

Invigilator
Note:
1. Reach before 30 minutes; show this card at the time of verification; read the instructions of the Answer-script carefully.
2. Carry a pen, pencil and an eraser.
3. Pager, mobile phone or any electronic gadget are not allowed in the Examination Hall.
4. Carry Admit Card for GD & Interview

Affix a stamp
size photo
Department of Management Studies
Hauz Khas, New Delhi 110016

ADMIT CARD
(Written Test for MBA-Part Time)

Name:
Address:

Candidate’s Signature Candidate’s Counter Sign

Invigilator
Note:
1. Reach before 30 minutes; show this card at the time of verification; read the instructions of the Answer-script
carefully.
2. Carry a pen, pencil and an eraser.
3. Pager, mobile phone or any electronic gadget are not allowed in the Examination Hall.
4. Carry Admit Card for GD & Interview