IMS

NAAC, NBA & IAO ACCREDITED

GHAZIABAD

Application Form
24th Batch 2014-16

Enquiry ID...................................
(For Ofce Use Only)

Afx your Passport Size Colour Photograph here

PGDM (2 Year Full time Programme)

Approved by AICTE, Ministry of HRD, Govt. of India

Personal Details Full Name (in Capital)

(As in High School/Secondary School Certicate): Date of Birth Family Member Father Mother Spouse Brother/ Sister

IMS
Birth Place:
(District & State)

Gender: M

Name

Age

Degree

University

Occupation/ Organization

Designation

GHAZIABAD
Rs. 3,00,001 - Rs. 5,00,000 Rs. 5,00,001 - Rs. 10,00,000 Above Rs. 10,00,000

Household Income (Per Annum)

Less than Rs. 3,00,000

Permanent Address: ............................................................................................... ............................................................................................... City: ...................................... District: .................................... State: .................................... Pin Code: ................................. Landline No.: Mobile No.:

Correspondence Address (If Different): ............................................................................................... ............................................................................................... City: ...................................... District: .................................... State: .................................... Pin Code: ................................. Email ID:

IMS
NAAC, NBA & IAO ACCREDITED

GHAZIABAD

Category: General
Source of Information:

SC

ST
Newspaper

OBC
TV

Other
Radio

Physically Handicapped:
Walk-in Reference

N
Education Fair Others

Hoarding

about IMS (Tick appropriate) Internet

Pass/Studying Students

Friends/Relatives

Educational Qualication Name of Level Class 10 10+2 Course Year Attended Name of Board / University Institution / College Aggregate Marks (%)

Graduation

Post Graduation

Any Gap::

Details of Entrance Examination CAT Percentile

IMS
From: To: Yr.1 Yr.2 Yr.3 Yr.4 Avg. Yr.1 Yr.2 From: To: Avg. N Number of Years: Reason: MAT Percentile CMAT Score Level (School/State/Region/ National/International) Y N Relationship Program

From: To:

GHAZIABAD
Distinction/Honour

Others if any, Please specify: Distinction/Honour (List your achievement in Sports, Cultural and Co-curricular activities) Activity

Does any of your sibling(s) studied/studying at any of the IMS Group Institution?

If yes, please give details. Name Year of Admission

IMS
NAAC, NBA & IAO ACCREDITED

GHAZIABAD

Would you require? Work Experience Y

Hostel Accommodation N

Transport Facility

If Yes, Name of the Organization ................................................... Designation .................................................................................. Hobbies

Industry ................................................................. No of Year ..............................................................

Document Checklist

Application Form with Afxed Photograph

Photocopy of Matric or Equivalent Certicate

Photocopy of Mark sheet of Qualifying Examination Photocopy of Entrance Exam Scorecard Proof of Distinctions / Honours Identication Proof

IMS
Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Place

Declaration by Student 1. 2. 3. 4. 5. 6.

GHAZIABAD

I hereby certify that the particulars furnished by me in the application form are correct. I undertake that I will not associate/involve myself in any unlawful activity. I undertake that I will neither smoke nor consume alcohol. Drugs or any other intoxicant, within Institute/hostel premises. I certify that I have never been debarred from appearing in any examination. I also declare that no police inquiry is pending against me. I fully understand and undertake that I will attend all classes as per institute time table. I also understand that I will not be allowed to appear in exam, in case my attendance falls below 80% level. 7. I undertake that I will submit my nal result before last date of admission failing which I will have no claim whatsoever and the institute may cancel my admission. 8. I also clearly understand that if I am found to be directly/indirectly involved in any case of ragging at any stage of my stay in the institute/Hostel, the institute will have the right to expel me from the institute and the hostel and register a criminal case against me, as per the direction of Honourable Supreme Court of India. 9. In case of dispute, the decision of Director shall be nal and binding. 10. I have read and understood the rules of discipline of the institute and shall abide by them. I also fully understand that in case of any violation, I can be detained in the trimester, rusticated, or expelled from the institute.

Date

Signature of the Student

IMS
NAAC, NBA & IAO ACCREDITED

GHAZIABAD

Declaration by Parent I .......................................... Parent/Guradian, do hereby declare that the information given is true and correct, I stand guarantee for good conduct of my ward during the course of his/her study in the Institute/Hostel. I, authorize to initiate disciplinary action against my ward for violation of any of the rules and regulation. I also promise to compensate the damages that may be caused by my ward due to his/her misconduct. I also promise to pay the fee as per the instructions issued to me through notice, failing which an appropriate penalty may be imposed by the University.

Date

Place

Signature of the Parent

IMS
INSTITUTE OF MANAGEMENT STUDIES
C-238, Bulandshahar Road Industrial Area, Lal Quan, GT Road, Ghaziabad 201009 (UP) INDIA Tel: +91.120.4170600 Fax: +91.120.2866034 Toll Free: 1800-102-4170 Mobile: +91.9711260686 / 9711856662 E-mail: admission@imsgzb.com

GHAZIABAD

www.ims-ghaziabad.ac.in