APPLICATION FORM

MBA ADMISSION
[BATCH: 2015 2017]

Post Graduate Institute of Management

Amrut Mody School of Management
Vikram Sarabhai Marg,
Opp. IIM, Navrangpura, Ahmedabad 380009
Web:www.pgim.ahduni.edu.in
Email: pgim.amsom@ahduni.edu.in
Phone : (079) 26301302, 26300048, Fax : 26301303

PLEASE AFFIX
PHOTOGRAPH
HERE

Personal Details

Mention the applicable test details

CAT Registration No.
____________________________

Total Score (out of)

Percentile

CMAT Roll No. (both scores)

(Sept)

(Sept)

(Feb)

(Feb)

1. Name and Address of the candidate: (In Block Letters)

First Name

Fathers Name

Mothers Name

Surname

2. Correspondence Address
Address Line 1
City / Town

State

Country

Pin code

Landline Number & Area Code

Mobile No. of Candidate
Number in case of Emergency
Email ID (BLOCK LETTERS)

3. Permanent Address
Address Line 1
City / Town

State

Country

Pin code

Ph. No. with Country & Area Code

4. Nationality :

Indian

Non-Indian

5. Gender :

Male

Female

6. Date of Birth :
D

7. Blood Group :
8. Category:

General

SEBC

ST

PH

Defense / Ex-Servicemen

SC
J&K

9. Parents / Guardians Occupation :

(Specify) : ________________________________________________________________________

Education
10. Academic Background
Examination
SSC
HSC
Graduate
Post Graduate
Any Other
(Please specify)

Degree /
Diploma

University /
Board

Principal Subjects /
Specialization

Year of
Passing

Percentage /
CGPA

Employment Details
14. Employment History (list only full-time employment from the most current employment):
Name of Employer

Designation

15. Total Work Experience:

Nature of Job

Years

From

To

Months

Documents to be included along with the application form are:

Attested copy of mark-sheet of final year of graduation. Those in the final year of graduation shall
attest mark-sheets of all the previous years.
Attested copy of mark-sheets of 10th and 12th Standard
CAT Score sheet / CMAT score sheet of the both attempts

Photo Identity Proof

Experience Certificate, (only full-time experience), if any
Caste Certificate (from competent authority as notified by the Government, if applied for
reservation quota)
Migration Certificate from competent authority along with Application (for J&K candidates)

Application Fees Payment Detail

Cheque/ Demand Draft of Rs. 500/- in favour of Ahmedabad University, payable at Ahmedabad.
DD / Cheque No.

Date :

Amount :

Drawn on (Bank Name)

Submission of Application Form

Duly filled Application Packet with required documents and application fees, should reach the institute,
marked to the Admissions Coordinator by Saturday, March 14, 2015.

DECLARATION
I have carefully read the instructions on the institutes website and agree to abide by the decisions of the
Institute 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.

Date : _________________

Signature of Candidate