Application Form

1
CAT SCORE (Percentile) Enrolment No
XAT SCORE (Composite) Enrolment No
MAT SCORE (Percentile) Enrolment No
Graduation Stream / Percentage
2 Full Name (Ms./Mrs./Mr.)
3 Date of Birth
4 Address for correspondence
5 Permanent Address
6 Father’s/Mother’s/Husband’s Name
7 Father’s/Mother’s/Husband’s Profession/Designation
8 Father’s/Mother’s/Husband’s Organisation & Address
9 Annual Family Income (Gross)
10 Nationality
11 Academic Qualifications

Examination Year Name of School/College & Location Board/
University		 Subjects
Studied		 % of
Marks		 Division
Awarded
Secondary (10)
Sr. Secondary (10+12)
Graduation-Degree
If Completed
If not Completed
Year 1
Year 2
Year 3

12 Post Graduation

Examination Year Name of School/College & Location Board/
University		 Subjects
Studied		 % of
Marks		 Division
Awarded

13 Experience details, if any

Name & Address of Organisation Designation From To Nature of Work Salary Drawn
14 Do you require hostel accommodation? Yes No
15 Do you require educational loan? Yes No
16 email