*Form No: APPLICATION FORM-2015 MASTER OF BUSINESS ADMINISTRATION (FULL-TIME) ----------------------------------------------------------------------------------------------------------------------------------------------------------------------Instructions 1. This form is an integral part of the admission process. Please provide correct information. Admission granted on incorrect information will be ipso facto null and void. 2. Fill in the application form legibly. Incomplete forms shall not be considered. Applicants 3. All applicants are required to appear for the Common Admission Test (CAT-2014) conducted by the Photograph Indian Institutes of Management (IIM). 4. This form should be sent only after you have received the CAT Admit card. An application form which does not indicate valid CAT Registration No. will not be considered. 5. Do not attach any certificates and mark sheets or their copies to this form for the general category 6. In all matters regarding admission to the programme, the decision of the University will be final and binding on the applicant. No correspondence from the applicant with respect to his/her non-selection will be entertained. The admission process at the University shall be subject to the jurisdiction of the courts of Ahmedabad. 7. *Form no. will be assigned by the Admissions office and the detail will be emailed to you. 8. Enclose a draft for Rs. 1,500/- drawn in favour of “Institute of Management, Nirma University” payable at Ahmedabad 9. The Admission process is subject to the conditions prescribed by the Government of Gujarat from time to time Demand Draft Details Bank Name Demand Draft No Demand Draft Date CAT Registration No. (Please attach photocopy of CAT Admit card) A. PERSONAL DETAILS Name (Block Letters): _________________________________________________________________________________ First Name Middle Name Surname Address (For Correspondence): __________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ City :__________________________________ Pin ____________________ State : ____________________________ Telephone __________________________________________ Mobile________________________________________ E-mail (Block Letters) (1)______________________________________________________________________________ (2)______________________________________________________________________________ Gender : Date of Birth: Male [ ] Female [ ] Date _____ Month _______ Year ______ Blood Group:__________________________________ Age (as on May 31, 2015): _____ years Nationality:_____________________________ Caste (GEN/OBC/ST/SC):_______________________________________ Father’s/ Guardian’s Name: __________________________________________________________________________ 1 B. EDUCATION 1. School Education Particular S.S.C (X) H.S.C (XII) Board Name Stream (Science / Commerce) Medium of Instruction Aggregate (%) Year of Passing Pass Attempt 2. First( ) Other( ) (Please Tick ) First( Other( ) (Please Tick ) ) College Education Have you completed your Bachelor’s Degree? Yes [ ] No [ ] Name of the Graduation Degree (Please mention the name of Degree such as B.Sc., B.Tech, B.com etc.) Stream (Science, Commerce, Arts, Mechanical, Electrical etc..) Mode of Study (Please Tick ) Full Time \ Distance \ Other University Name Medium of Instruction English \ Other (Please Tick) Year of Admission Year of Passing Aggregate Percentage Have you passed all examinations in single attempt? Yes ( ) No ( ) (Please Tick ) (Students who have passed all examinations (course-wise) in the first attempt only should indicate passing attempt as “First”) Note : Final year students should indicate percentage of aggregate marks obtained in all the previous examinations. C. Sr. No. WORK EXPERIENCE (ONLY FULL-TIME JOB AFTER GRADUATION IN A PROFESSIONAL ORGANIZATION) Organisation Position From Period (in months) To Total Number of Months 2 Total D. CHOICE OF INTERVIEW CENTRE (IF SHORT-LISTED): Please mark clearly only one centre 1 Ahmedabad ( ) 2 Bangalore ( ) 4 New Delhi ( ) 5 Pune ( ) 3 Kolkata ( ) The University reserves the right to cancel any of the centre at its discretion. E. ARE YOU APPLYING IN THE CATEGORY OF FOREIGN NATIONALS/PERSONS OF INDIAN ORIGIN (PIO)/NON RESIDENT INDIANS (NRI) /NRI SPONSORED / CHILDREN OF INDIAN WORKERS OF GULF COUNTRIES AND SOUTH EAST ASIA? Yes [ ] No [ ] If yes, please tick in the appropriate box (√) below and enclose a bank draft for US $ 115 or Rs.5,000/- drawn in favour of “Institute of Management, Nirma University” payable at Ahmedabad as processing fee. Candidates having already paid Rs.1500/- or US$ 35 for the application fee are required to pay only Rs. 3500/- or US$ 80. 1. 3. 5. *Foreign National *Non Resident Indian *Gulf Quota ( ( ( ) ) ) 2. 4. *Person of Indian Origin ( **NRI Sponsored ( ) ) Bank Details D.D. No : ____________________ Bank Name : __________________________ Date : ______________________ Note : * Candidates applying in a particular category are required to enclose the document verifying their status to be eligible for consideration in that category. * Candidates applying through GMAT need to submit their GMAT score latest by February 28, 2015. ** Only Candidates appearing for CAT-2014 are eligible to apply under NRI Sponsored Category. F. DECLARATION: I have carefully read the instructions and agree to abide by the decision of the University regarding my selection to the programme. I certify that the information furnished in this application form is correct to the best of my knowledge and belief. Place: ___________________ Signature of the Applicant Date: ___________________ All communication with regard to admission will be online or through electronic mails and therefore the candidates are advised to keep track of the online information at our website (nirmauni.ac.in/im) and their email provided to us during the Admission-2015 process period. The completed application form should be submitted to the Deputy Registrar, Institute of Management, Nirma University, S.G. Highway, P.O. Chharodi, Ahmedabad-382481, Gujarat latest by December 15, 2014. 3