Form no MAH-MBA-CET-15/ Receipt No.--------------- G. H. RAISONI COLLEGE OF ENGINEERING, NAGPUR (An Autonomous Institute by UGC Act & Affiliated to RTM Nagpur University) Date ADMISSION REQUEST FORM MBA First Year - 2015-16 (Minority Seats) Affix recent passport size photograph Demand Draft Details: Amount: 1000/-DD. No. -------------------- D.D. Date: ------------------------------Bank Name: ---------------------------------------- Branch: ------------------------Name of the Candidate: (First name, Father’s name and surname in capital letters) Mother’s name: Address for communication: City: Pin Code: e-mail address: Phone number :( R) Mobile: Mother Tongue: Gender: Male Mobile: Religion: Female Date of Birth: State of Domicile: Examination Passed Nationality: Caste Category: SC/ST/VJ/NT/OBC/General Name of the Max. Board / University Marks Marks Percentage Obtained (Aggregate) Month &Year of Passing SSC HSSC Graduation Degree (Specify) Studied English subject at Degree level (YES/NO) Details of Entrance Examination State Merit No. Application ID Roll No. Score MAH-MBA-CET -2015 Kindly consider my Admission Request Form for preliminary scrutiny and the preparation of merit list for Minority quota seats. I shall complete the necessary formalities required as per the procedure as and when declared/ published. Information furnished by me in this application is true to the best of my knowledge and belief. Signature of Candidate: Date Note: Incomplete applications in any case will not be processed. Please attach attested Photo copies of required document. ----------------- I have enclosed the following attested Photo copies of document. Sr.No Documents Please Tick 1 S.S.C. (Std. X) mark sheet. 2 3 4 H.S.C. (Std. XII) mark sheet. Graduation Mark sheets (I/ II / III ) YEAR College leaving certificate after passing Graduation. 5 6 Certificate of the Indian Nationality of the candidate. Statement of marks for the Bachelor’s Degree Examination (i.e. the qualifying degree) 7 Migration Certificate (if required) 8 Gap Certificate on 50 Rs. Stamp paper if Graduation Examination passed in 2014-15 or before 9 10 MAH-MBA-CET-2015 Score Card Eligibility Certificate ( if required) 11 Domicile certificate of candidate indicating that he/she is domiciled of which State 12 13 Hindi Knowing Affidavit at the time of admission. Any Other DECLARATION TO BE SIGNED BY THE APPLICANT I-----------------------------------------------------------------------------------------------------------declare that: The information given by me in this application is true to the best of my knowledge and belief. I have filled this application form for the consideration of admission to M.B.A. First Year through Minority Quota. Date: / /2015 Place: Nagpur Signature of Candidate DECLARATION TO BE SIGNED BY THE PARENT/GUARDIAN I-----------------------------------------------------------------------------------------------------------declare that: The information given by my s o n /daughter/ward in this application is true to the best of my knowledge and belief. I will sign requisite affidavit / bond as prescribed by the Authority for minority candidates. Date: / /2015 Place: Nagpur Signature of Parent/Guardian ACKNOWLEDGEMENT:- Received dully filled ARF No. --------- of Mr. ------------------------------------------------------towards First Year MBA Admission (2015-16) to GHRCE. You are requested to visit our college website http://ghrce.raisoni.net for detail rules and schedule regarding admission process. Date: …/…/2015 Signature G.H.R.C.E., Nagpur
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