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AMRITA SCHOOL OF BUSINESS


MBA and MBA-MS APPLICATION FORM (2015 - 2017)

Form No:

To be received latest by February 22, 2015.

PREFERRED RESIDENTIAL STATUS ():


Residential
Day Scholar *

CAMPUS PREFERENCE: (Write 1-4 in the boxes below, 1 indicating first choice)
Amritapuri
Bengaluru
Coimbatore
Kochi
\

*Students who are living with their parents in the city where the campus is located can avail this facility, if they are located within 30 km from campus.

Provide your test details below. Attach a photocopy of your test score.
TEST
CAT
MAT
XAT
Reg /Form/Roll No.

Form No.

GRE

GMAT

CMAT

Score

Score

Score

Roll No.

Test date:
Percentile/Score:

Percentile

Composite percentile

Percentile

Email used for Reg:

Choice of ASB Centre for the Personal Interview (Please one):


Bhubaneswar

Chennai

Coimbatore

Ahmedabad

Hyderabad

Kochi

Kolkata

Amritapuri

Lucknow

Bengaluru

Mumbai

New Delhi

PERSONAL DETAILS
Name in BLOCK letters (As per your degree certificate)

Age
Years

Date of Birth
Months

Male

Community / Caste

Religion

OC

Marital Status

Gender

BC

Mailing Address

OBC

Mother Tongue
MBC

SC

STD code

Married

Blood Group

ST
Permanent Address

Pin
Phone:

Single

Female

Pin
Number

Phone:

Mobile:

Mobile:

Email:

Email:

STD code

Parent/Guardian Name:

Number

Age:

Occupation:

Mobile:

Email:

Phone:

STD

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ACADEMIC QUALIFICATIONS:

Please enclose attested copies of the certificates

Name of
Examination

Level

School-Board / collegeUniversity

Year

Branch

From

To

Percentage /
GPA

10th Standard
12th Standard
UG Degree
PG Degree
Other

Please account for breaks in your academic career, if any and why?

MERITORIOUS and CO-CURRICULAR ACHIEVEMENTS:


(Academic/Professional Awards/Medals/Prizes/Scholarship/Certificates/Honours, etc.)
No.

Name of Award

Awarding Institution

Please enclose self-attested copies.

Academic Level

Basis of Award

Year

1.
2.
3.

WORK EXPERIENCE:
No.

Name & Address of the Organization

(Please furnish a certificate from the last employer)


Period
Nature of Job
Monthly Salary
From
To

Designation

1.
2.
3.

REFERENCES: Should not be close relatives.


Name:

Name:

Occupation:

Occupation:

Address:

Address:

Pin
Phone:

STD code

Pin

Number

Phone:

Mobile:

Mobile:

Email:

Email:

STD code

Number

How did you come to know of ASB?


1. CAT Coaching Centres:
2. Newspaper:
3.

Internet
Friends

AIMA

IMS

T.I.M.E.

PT Education

The Hindu

Times of India

Amrita University

M.A. MATH

Relatives

Career Launcher

Other (please specify)

Indian Express

Other (please specify)

IIMs

MBA Universe

PagalGuy

Alumni

Other (please specify)

DECLARATION
All entries made in the application form are true to the best of my knowledge and belief. I am willing to produce original
certificates on demand at any time. I also undertake that I shall abide by the rules and regulations of ASB and the University.

Place:

Date:

(Signature of the Applicant)


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