Kohinoor Business School Centre for Management Research - Khandala ( AICTE Approved ) Application Form Sample Form Post Graduate Diploma in Management: 2010-12 Instructions: 1. Please read the Application form carefully before filling. This form is an integral part of the admission process. Admission granted on the basis of incorrect information will be ipso facto null and void. 2. 3. Fill the application form in BLOCK LETTERS and in candidate's own handwriting. The complete application form should reach Admission Office, Kohinoor Corporate Office, Affix passport Senapati Bapat Marg, Dadar (West), Mumbai - 400 028 at the earliest. 4. size recent Please enclose a photocopy of the CAT/XAT/MAT/ATMA/ MH-CET scorecard only and no other documents color photograph should be attached with the application form. If the scorecard is not available, please enclose a photocopy of the admit card. 5. Please note that incomplete application form will be rejected. 6. Kindly attach a DD of Rs 1000/- with this application form in favor of “Kohinoor Business School & CMR” payable at Mumbai. 7. In all matters regarding admission to the program, the decision of KBSCMR will be final and binding on the applicant. No correspondence from the applicant with respect to his/her non-selection will be entertained. PGDM Choice of specialization : Marketing Human Resource Finance Information Technology International Business Please indicate your choice in order of preference by marking 1, 2, 3, 4 in the boxes Full Name First Name Gender Male Middle Name Date of Birth Female Place of Birth Category Mother Tongue Physically Challenged E-mail id Marital Status Yes No Last Name Single If yes please specify Open Married OBC Nationality SC ST E D U C AT I O N T R U S T Current Address City State Phone No. Postal Code Mobile No. With Area Code Permanent Address City State Phone No. Postal Code Mobile No. With Area Code Father's / Mother's Name First Name Occupation Position Held List some of your achievements ? List your strengths and areas of improvement, if any Middle Name Organization Last Name Kohinoor Business School Centre for Management Research - Khandala ( AICTE Approved ) Give a brief description of your career goals. Explain how this course would help you attain them ? EDUCATIONAL DETAILS Examination Board / University Location Passing Year Percentage Academic Stream S.S.C. H.S.C. Post Graduation M.A / M.Sc. / M.Com / M.Tech / Other Please Specify Other Examination Please Specify • Grade Points should be converted to percentage of marks • Percentage should be computed after taking into account subjects/ papers that are being considered by the Board/University/Institute • Candidates in the final year of Graduation/Post Graduation should indicate the aggregate marks obtained till the latest examination for which results are available • Candidates appearing for the final year degree examination will be given provisional admission subject to submission of final certificates by 30th Sept, 2010 FULL TIME WORK EXPERIENCE Name of Company Location Duration in Months Annual Salary E D U C AT I O N T R U S T Describe your present job profile and responsibilities TEST TAKEN Test CAT XAT MAT ATMA MH-CET Registration Number / ID No Percentile Scored GD/PI CENTER • Agra • Ahmedabad • Bangalore • Bhubaneshwar • Dehradun • Delhi • Hissar • Indore • Jaipur • Jamshedpur • Kanpur • Khandala • Kolkatta • Lucknow • Mumbai • Hyderabad • Chennai Kindly indicate 2 centers of your choice in order of preference : Preference 1: Preference 2: Note : KBS reserves the right to change or cancel any centre at its discretion. HOW DID YOU GET INFORMATION ABOUT KBS? News Paper Other Seminar Magazine Mailer Exhibition Coaching Institute ________________ Please Specify DECLARATION 1. I hereby declare that the information given by me is true to the best of my knowledge and Applicant's Signature belief. If at any stage it is found that I do not satisfy the admission criteria or the information furnished by me is incorrect, my application to the course stands cancelled. 2. I have read and understood the rules and regulation with respect to admissions, fee for the program (including government taxes if applicable), fee refund provided in the prospectus and agree to abide by them. The decision of the institute will be final and binding. All disputes pertaining to matters of admission and its terms and conditions are subject to Mumbai Jurisdiction. Place Date