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Registration Form

Applied for

MBA Prime
First Name:
Middle Name:
Last Name:
Dath of Birth:
Nationality:
Blood Group:
Gender:
Male
Female
Aadhaar NO:
PAN Card:
Permanent Address:
City:
State:
PinCode:
Your Current Address:
City:
State:
PinCode:
Mobile NO:
Email ID:
Parent/Guardian Information:
Father's Name: Occupation: Mother's Name: Occupation: Address: Mobile: Email: Family Annual Income:
Academic Record
Class X :
School/Institution
Board/University
Year of Passing
Specialization
Percentage/CGPA
Class XII :
School/Institution
Board/University
Year of Passing
Specialization
Percentage/CGPA
Graduation :
School/Institution
Board/ University
Year of Passing
Specialization
Percentage/CGPA
Other Qulification (If Any) :
School/Institution
Board/ University
Year of Passing
Specialization
Percentage/CGPA
Category :
General
OBC
SC
ST
Other
Entrance Exam :
CAT
MTA
CMAT
ATMA
MHCET
Score :

Work Experirnce (If Any) :
Organization
Duration
Role
Why do you want to pursue this course? Sepecialization willing to opt in 2 nd Year:
* How did get to know about MBA@IICMR :
Advertisement Alumni Friend
Other
Declaration by the candidate

"I declare that I am applying for admission with the consent of my parents/guardian and that the particulars given above are correct. I have read the college prospectus as well as the admission requirements as laid down by the University for the Course. I agree to abide by the rules and regulations given therein. I further declare that I shall submit myself to disciplinary jurisdiction of the Principal of the college, the Vice-Chancellor and the other authorities of the University who may be vested with the power to exercise discipline under the Act the Statutes the Ordinances and Rules framed by the University in this regard. I understand that my admission if made by the college is provisional and will be subject to confirmation by the University. In case my admission is cancelled by the University I shall have no claim for refund of fees paid by me to the college or the University

I undertake that I shall not indulge in any act of ragging otherwise my admission to the college stand cancelled and disciplinary proceedings be initiated against me"

Date :
Place :

Note: Application Form Fee will be Rs. 1000/-