M.S.

RAMAIAH INSTITUTE OF MANAGEMENT

(Post Graduate Centre for Management Studies and Research)
(Approved by the All India Council for Technical Education, New Delhi & Ministry of Human Resources, Govt. of India)

Post Box No: 5405, M. S. Ramaiah Nagar, MSRIT Post, Bangalore 560 054 Phone: 080-23608769 (5 lines), Mobile: 9482571103 Fax : 080-23601947 e-mail : dean@msrim.org Website : www.msrim.org

APPLICATION FOR ADMISSION TO TWO YEAR POST GRADUATE DIPLOMA IN MANAGEMENT (PGDM)

Application Serial No.

(To be filled up by the office)

(FILL IN BLOCK LETTERS) 1. 2. Name of the Candidate (i) Fathers Name (ii) Mothers Name 3. 4. Name of the guardian and relationship if the father is not alive Permanent address of the candidate

5. 6. 7. 8.

Phone : e-mail ID: Blood Group: Mobile No. of the Candidate Mobile No. of the Guardian

9.

ii) Local Address (if any)

Phone :
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10.

Details of Parent / Guardian a. Qualification b. Occupation c. Income (Annual) (i) Date of Birth (dd-mm-yyyy) (ii) Place of Birth (Enter Place, Taluk and District)

Father

Mother

11.

(iii) State of Domicile (iv) Mother Tongue 12. Name and address of two responsible persons who can vouch for the candidates character

a) b)

13.

Name and address of the principal of the institution where he/she studied last Phone No :

14. Whether SC/ST/I/IIA/IIB/IIIA/IIIB/GENERAL MERIT (Enclose a copy of Caste Certificate)

DEGREE EXAMINATION 1. Name of Qualifying Degree : 2. College : 3. University : AGGREGATE MARKS FOR ALL THE YEARS / SEMESTERS Year / Semester Total Marks Min-Marks 1 Year / I Semester II Semester II Year / III Semester IV Semester III Year / V Semester VI Semester IV Year / VII Semester VIII Semester

4. State 5. Reg. No. 6. Year of Passing

: : :

Marks Obtained

Percentage

Grand Total WORK EXPERIENCE (JOB TITLE) a. .. b. .. c. .. COMPANY .. .. .. FROM . . . TO . . .

DECLARATION BY THE CANDIDATE

I wish to apply for admission to M.S. Ramaiah Institute of Management and declare that I have filled this form myself and to the best of my knowledge and belief, the above particulars are true. I agree if admitted to the course to conform to the rules & regulations in force from time to time of the institute. I undertake that so long as I am student of the institute, I will do nothing unworthy of a student of the institute either inside or outside or anything that will interfere with its orderly working and discipline. I am aware that the management has full authority to expel me for disinterest in studies, misbehaviour and continuous failure. I agree to adhere to the rules & regulations, scheme of study and examinations prescribed by the appropriate authority. Place: Date: Candidates Signature

PLEASE ANSWER THE QUESTION 1. List out your 3 strengths & weakness. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________
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DECLARATION BY THE PARENT / GUARDIAN

We assure you that our ward will adhere himself/herself to the conduct & rules of the institution. Further, we also undertake to pay tuition fees, all dues, damages and fines if any to the institution in time. We understand and agree that if our ward misbehaves or acts against the interest of the institution he / she can be rusticated. We take full responsibility with regard to his / her conduct. Place : Date : Signature of the parent / Guardian

IMPORTANT NOTES : Copies of the following certificates should be enclosed at the time of selection:
1. Marks Card of qualifying Examination 2. MAT / CAT / XAT / ATMA / GMAT / CMAT Score Card

NOTE: Originals of the following shall be submitted at the time of at the time of admission without which the admission will be cancelled:
1. 2. 3. 4. 5. Marks Card of qualifying Examination Transfer Certificate from the Institution last attended Migration Certificate from the Board / University Character / Conduct Certificate from Institution Certificate in proof of Date of Birth