Management & Research Institute
Management & Research Institute To The Director, Hubtown Solaris, 2nd Floor, N.S. Phadake Marg, Near East West, Flyover , Andheri (East), Mumbai- 400 069 Affix your latest clear passport size photo here. (Do not staple or sign on photo) -----------------------------------------------------------------------------------------------------------------------------------------Provisional Admission Form for Ph.D/MBA Program Affix your latest clear passport size photo here. (Do not staple or sign on photo) Session: ………………………… HO No./Registration No. ……………………………………….……………………..…. Signature here Course ……………………………,Specialization ……………………….…………….. PERSONAL INFORMATION 1. Candidate Full Name in English ……………………………………………………………………………………………..……………… 2. Father's Name ……………………………………………………………………………………………………………… 3. Mother's Name …………………….……………………………………………………………………………………… 4. Husband Name ………………………………………………………………………………………………….…………… 5. Sex (Male/Female) ……………. Cast: SC/ST/OBC/SBC/GEN. Date of Birth (DD/MM/YYYY)…….………... 7. Nationality: □ Indian / □ Other Country, Please Specify…………………………………………………..………………………… 8. Particular of Qualifying Examinations S.No. Exam Passed Board/ University Percentage Year of Passing 9. Complete Postal Address Pincode Phone No. with Code Mobile NO. 10. E-Mail id. …………………………………………………………………………………………………………………………………………… 11. Pre Qualifying Test GATE/NET/SLET/JRF/M.Phil or any other (for P.hD candidate) Name of Passing Year of Passing Roll No. Rank/ Percentage 12. Major Area of Research (for PhD candidate) …………………………………………………………………………… …………………………………………………………………………………. 13. Publication of Books / Referred Journal or any other extracurricular activity (if any), (for PhD candidate): ……………………………………………………………………………………………………………………………………………………… 14. If Employed (Give detail) or Professional Experience ……………………………………………………………………………………………………………………………………………………… PARTICULAR OF SUGGESTED GUIDE/SUPERVISOR (If any), (for PhD candidate) 1. Name & Designation ……………………………………………………………………………………………………………………… 2. Working Address…………………………………………………………………………………………………………………………… 3. Correspondence Address (Residence)……………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………… DECLARATION BY CANDIDATE I hereby declare that the information given in application form is complete and accurate. I understand and agree that misrepresentation or concealment of facts will result in denial of admission, cancellation of admission, or expulsion. I am aware of the fee structure and eligibility criteria for admission in the Board/University, I have read, understood and do hereby give consent to the terms and condition of the Board/University ordinance for admission. I agree to abide by the admission rules and decision taken by the Board/University authorities in all issue pertaining to admission and my continuation as a student of the Board/University. Place: Date: Signature of the Candidate (The Demand Draft drawn in the favor of MRI, Payable at Mumbai, Should be sent to Director) To The Director, Hubtown Solaris, 2nd Floor, N.S. Phadake Marg, Near East West, Flyover , Andheri (East), Mumbai- 400 069 Fees Particulars: Bank & Branch ……………………………………………………………….…… Amount ………………………………….…………..… DD No…………………………………………………………. DD Date………………………………………………………………………….. Checklist for Candidates Documents to be submitted by Ph.D/MBA Candidates at the time of Admission 6 Passport Size Photographs. Filled Application Form. Attested copy of 10th Mark sheet & Certificate Attested copy of 12th Mark sheet and Certificate Attested copies of all Mark sheets and Convocation of Graduation Attested copies of all Mark sheets and Passing of Post Graduation Migration Certificate (Original) Caste Certificate (For Relaxation in reserved category) No Objection Certificate (In the case of Candidate working in any organization) Signature of the Candidate For O ce Use Only I have checked the following documents which are essentials for the eligibility of the Ph.D/MBA Program □ Proof of Date of Birth □ Migration Certi cate □ All Qualifying Exam Mark sheet. □ Caste Certi cate Date: Signature of O cials: Management & Research Institute Undertaking Form (By Student) To The Director Institute of Management & Engineering Technology Hubtown Solaris, 2nd Floor, N.S. Phadake Marg, Near East West, Flyover , Andheri (East), Mumbai- 400 069 Sir / Madam, This is to declare that I _______________________________________________ son / daughter of __________________________________have taken admission in ______________________ Program in winter / summer 20___ in _________________________________________steam under Institute of Management & Engineering Technology and I assure that all the documents enclosed Related to my qualification regarding the admission are genuine and authentic. In the event of suppression or distortion of any fact like educational qualification, 1documents related to nationality and study period etc. made in application form. I understand that my admission is liable to be cancelled. I am eligible for the examination as per the rules and regulations of the board. I shall be responsible for The consequences if the information filled by me is found incorrect. if I am found ineligible for admission to a class, at any stage my application will be rejected even if my result has been finally declared and Consequently such result also would be void. I have gone thought the rules, regulations and educational programs offered by the said board and on being fully satisfied, I have applied for admission on my own. Hence I am aware that the programmers offered by the said board come under Autonomous board and An ISO 9001: 2008 institution, however if I am unable to get advantage out of said programmers after its completion, in securing job promotion and /Or for further advance studies on any accounts and for any other reason, the said board will not be held Responsible in any manner and also undertake not to claim. Place: __________________Date: __________________ Signature of the Candidate
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