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Registration Form: Post Graduate Diploma in Management (PGDM) 2012-2015 (Part Time

INDUSTRIAL TRAINING REPORT ON Wbfgg

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Mishti Ritz Mukherjee
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27 views

Registration Form: Post Graduate Diploma in Management (PGDM) 2012-2015 (Part Time

INDUSTRIAL TRAINING REPORT ON Wbfgg

Uploaded by

Mishti Ritz Mukherjee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Copernicus Lane, K.G. Marg, New Delhi 110 001, Tel. 011-23073852, Web: www.bulmim.ac.

in

REGISTRATION FORM
Post Graduate Diploma in Management (PGDM) 2012-2015 (Part Time)
AICTE Approved
REGN SL. NO.

RECEIPT NO.

COMPOSITE SCORE CAT/MAT/XAT____________________________

PGDM Choice of
Specialisation:
Finance

cAT

REGN. NO: ____________________

(Indicate 2 choices only)


Marketing

HR

Information Technology

Entrepreneurship

Please affix
recent passport
photograph

Applicants Personal Details:

___________________________(Please Fill in Capital Letters)


Name......
Date Of Birth :
/
/
Sex: Male/Female Nationality Category(SC/ST/BC/OBC/EWS/GEN/PH)
dd/mm/yyyy )
Fathers Name........
(First Name
Middle Name
Last Name )
Occupation....Mob No.Tel. No (Res.)
Mothers Name........
(First Name
Middle Name
Last Name )
Occupation...Mob No..Tel. No (Res.)
Parents E-mail ID.Applicants E-mail ID

Address for Communication:


______________________________________________________________________________

..........................................................................................................City.............................................Pincode............................................
State..............................................................Mob. No.......................................................Tel. No (Res)...
(STD Code)

Permanent Address:

____________________________________________________________________________
Communication

..........................................................................................................City.............................................Pincode............................................
State..............................................................Mob. No.......................................................Tel. No (Res.)...
(STD Code)

(Pls mention the Degree)

Academic Records:
Qualification

Name of the Institution

University/Board

Main Subjects

Year

Cumulative
% of Marks

POST GRADUATION
GRADUATION
CLASS XII
CLASS X

Extra Curricular Activities:

_____________________________________________________________________________
Sl.No

Nature of Activities

School Level

University Level

National Level

Employment Details:

_____________________________________________________________________________
DETAILS OF WORK EXPERIENCE (List Chronologically Beginning With Present Employment)
Name of Company and Address
with contact numbers

Details of work experience


Date

Designation & Broad Responsibilities

Salary Drawn

HOW DID YOU COME TO LEARN ABOUT BULMIM? Word of Mouth

Alumni

MAT Bulletin

Newspapers (Mention the Name..) Coaching center


ANY OTHER INFORMATION. (which you may think relevant to this admission)
ARE YOU PRESENTLY DOING ANY OTHER COURSES? (If so, please mention them)

DECLARATION
I hereby certify that the information furnished in the Application form is complete, accurate and true. I have
carefully read the contents of the prospectus together with enclosures/inserts and agree to all the conditions
mentioned therein. If admitted, I agree to abide by the rules and regulations of BULMIM as may be in force
from time to time. I understand that any information furnished falsely and / or misrepresented/suppressed is
a sufficient ground for summarily canceling my admission and / or expulsion from the institute.
Place:

Name:

Date:

Signature of the Applicant :

ENCLOSURES: 1. DD/Pay Order of Rs. 1100/- in favor of BULMIM payable at New Delhi.

2.
3.
4.
5.
6.

Copies of Marks Sheet & certificates of 10th,12th and Graduation.


Copy of Certificate of Graduation.
Sponsorship (if any) of the employer.
Two recent passport size photos.
Copy of Score Card of CAT/MAT/XAT

FOR OFFICIAL PURPOSE:


Recd By

Checked By

Remarks

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