Post Graduate Program for Executives Visionary

Leaders for Manufacturing (PGPEX-VLFM)

APPLICATION FORM V1.0

PGPEX-VLFM: 2017-18

PERSONAL INFORMATION
NAME
VIKALP
SHRI
BACHCHAN
Gender
Male

PLACE OF ISSUE-BAREILLY,U.P.

Marital Status

Single

Personal email id
Preferred Address for communication
*Company Address
Permanent Address
 APPLICATION FEE
Rs. 2,500/- (Non-refundable) for Indian nationals and USD 100/- for NRI / Foreign Nationals/ Applications sent from
outside India.
Demand Draft should be drawn in favor of NITIE, Mumbai, payable at Mumbai, India.
Dema Demand Draft DD number Date DD Date.
nd Number
Draft Name of Bank DD issuing bank. Branch Bank Branch.

Online Name of Account: Name of Bank: State Bank Branch: NITIE- SBI,
mode NITIE, Mumbai of India (SBI) Vihar lake, Powai,
Mumbai, India
A/C no. IFSC code Transaction id: Insert Date:
transaction id

FUNDING OF PROGRAM
The tuition fee for the PGPEX-VLFM is Rs. 12, 50,000/- (Indian Rupees Twelve lakhs a n d fi f t y
t h o u s a n d only), subject to revision. Rs. 50,000/- (Rupees Fifty thousand only) has to be paid as
refundable caution deposit at the time of registration. The tuition fee does not include boarding and
lodging at respective institutes, travel between NITIE and IITD and international travel and related
expenses.
How Do you Own Fund Bank loan* Company Others ____Click
propose to pay for Sponsorship here to enter
this course (Tick text.________
applicable)
How did you come Colleagues Top Management Advertise Social media
to know about the Twitter
program
LinkedIn
course (Tick
Google plus
applicable)
Facebook
Others _______Click
here to enter
text._______
Category of Self-Sponsored Self-Sponsored (On Sponsored c
Application course (Resigning from study leave) b
(Tick applicable) present job)a

(a) Sponsored: Candidates applying under Sponsored category must submit letter of intent of
sponsorship issued by the employer with the application form and submit attested copy of
letter/bond from the employer containing the details of terms and conditions and extent of
sponsorship on or before registration.

(b) Self Sponsored Study Leave: Candidates in service applying under this category must
submit with application form, attested copy of the application for study leave bearing signature
and seal of the employer along with letter or endorsement of consent of the employer on the
application.

(c) Self Sponsored Resign: In case of candidates who plan to resign from service, letter of
resignation and release from employer is to be produced in original on or before registration.
 ACADEMIC CREDENTIALS
Exam/ Degree University/Board CGPA / Division Year
Percent of
age Passi
ng
Secondary ICSE BOARD 65 1 2006
(Class 10 or
equivalent)
Higher CBSE BOARD 67 1 2008
secondary (12th
equivalent)
Diploma (if Click here to enter text. Specialization- Click Click Click
applicable) Insert here to here to here
specialization enter enter to
text. text. enter
text.
Under Graduate UPTU Click here to Specialization- 70.58 1 2012
Engineering / enter text. MECHANICAL
AMIE ENGINEERING
B.Tech B.E.
Masters / Post Click here to enter text. Specialization- Click Click Click
graduate degree Insert here to here to here
(if any) specialization enter enter to
M. Tech text. text. enter
text.
M. E.
M. S.
MBA
OTHERS

Registration Number Click here to enter text.

Test Date:

TOEFEL / IELTS
For International Score Percentile
candidate, only Verbal Click here to enter text. Click here to enter text.
Quantitative Click here to enter text. Click here to enter text.
Overall Click here to enter text. Click here to enter text.
AWA Click here to enter text. Click here to enter text.
 WORK EXPERIENCE
Aggregate full 5 years 1 months
time work-
experience
(In completed years and
months as on 1 s t
September 2017)
Managerial work- 1.5 years 0 months
experience
(In completed years and
months out of aggregate
work-experience given
Company Name ALTAIR ENGINEERING INDIA PRIVATE LIMITED

Industry ENGINEERING CONSULTANCY

Address Mercury 2B Block, 5th FLR., Prestige Tech Park, Marathahalli Outer Ring
Road Bangalore.

Postal Code 560103

Your current
employer State KARNATAKA Countr INDIA
y

Tel. 080 6629 4500 Fax Click here to enter

text.

E-Mail Vikalp.bachchan@altair.com

Website http://www.altair-india.in/

Total employees 2600+

Annual sales (INR) Click here to enter text.

Main field of Activity ENGINEERING CONSULTANCY-

NUCLEAR/AUTOMOBILE/AEROSPACE.
SENIOR PROJECT ENGINEER
Job title / Designation

Area of expertise PIPING

No. of years in this 1.5

Your current job
position

No. of reportees 2

Understanding client requirements and execution with

Assets under optimization.
your
arrangement Mr Gopalkrishna Pai ,Project Leader , 230/2 Sector-14
Name, Designation, Gandhinagar ,Gujarat-382016 ,
Postal Address, gopalkrishna.pai@altair.com , 07405339551
Email and Phone
Your direct supervisor details
Mr Vasantha Kumar-Sr Project Manager
To whom does he/she
report
Last Pay Details
Please enclose copy of the last pay certificate for the month preceding the month of submission of application.
Basic Click here to D.A. Click here to enter text. Total Click here
enter text. to enter
text.

Other Information Click here to enter text.

Is your employer prepared to provide you with Choose an item.

facilities/access to undertake in-company project
during final months of the program?

Your Job Description

Please give a description of your exact job, including nature of work, major responsibilities etc. (If possible,
draw an organization chart and give your job description. Use extra sheets, if necessary)..
 CAREER SUMMARY
Name of organization JINDAL SAW LTD
Industry API-HSAW/LSAW PIPE MANUFACTURING
Complete address including contact numbers VILLAGE SULTANPUR, TALUKA SANDUR, BELLARY,
KARNATAKA 583115
Website address http://www.jindalsaw.com/
Starting date

1. Ending date

Last designation EXECUTIVE ENGINEER

Functional area of work MECHANICAL MAINTENACE AND PROJECT ERECTION
COMMISSIONING
Last drawn salary Click here to enter text.
International exposure (if any) Click here to enter text.
Reason for leaving Click here to enter text.
Name of organization GREENLEAF ENGINEERING LTD
Industry ENGINEERING CONSULTANCY
Complete address including contact numbers E-45, 2nd Floor, Sector 63, Noida, Uttar Pradesh
201301 PH-0120 454 7826
Website address http://www.gel-world.com/
Starting date

2.
Ending date

Last designation DESIGN ENGINEER

Functional area of work PIPING DESING AND SIMULATION
Last drawn salary Click here to enter text.
International exposure (if any) Click here to enter text.
Reason for leaving COMPANY CLOSED.
Name of organization Click here to enter text.
Industry Click here to enter text.
Complete address including contact numbers Click here to enter text.
Website address Click here to enter text.
Starting date

3. Ending date

Last designation Click here to enter text.

Functional area of work Click here to enter text.
Last drawn salary Click here to enter text.
International exposure (if any) Click here to enter text.
Reason for leaving Click here to enter text.
 ACTIVITIES AND INTERESTS COCURRICULAR, EXTRACURRICULAR
Activities/ Interest
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
Award/Certificates
Click here to enter text.
Click here to enter text.
Click here to enter text.
Key involvements/achievements
Click here to enter text.
Click here to enter text.
Click here to enter text.
Click here to enter text.
AWARDS AND CERTIFICATES
Awarded By Domain Year of Award
Click here to enter text. Click here to enter text. Click here to enter text.
Click here to enter text. Click here to enter text. Click here to enter text.
Click here to enter text. Click here to enter text. Click here to enter text.
 STATEMENT OF PURPOSE (WORD LIMIT 500 WORDS)
The Statement of Purpose and Objectives for joining PGPEX-VLFM - is your opportunity to
inform the faculty of your motivation, passion and potential to contribute in the field of
manufacturing.

Start writing from here and restrict to 500 words limit

 DESCRIPTIVE QUESTIONS (300 WORDS EACH)
BUSINESS is the most passionate thing for me. From my childhood I was in the
environment of business because all our family and relatives were involved in business.

What do you feel most

passionate about in
your life? Please
identify and write a
point in your life when
your passion helped
you to capture an
opportunity?

Start writing from here and restrict to 300 words limits.

Describe any two

instances in your career
where the situation was
highly stressful and
unfavorable. What were
a few steps taken by
you to move out of
such adverse situation
during mentioned two
instances?

Start writing from here and restrict to 300 words limits.

Based on your work

experience tell us about
a time when you
managed the team
effectively and a time
when you failed in
doing so?
 REFERENCES
Two letters of recommendation in the format given must be sent to the Institute within the application deadline
date. The recommenders should separately seal the envelopes and sign on the flap.
Please list below the name and complete address of the recommender. Each should be well acquainted with your
intellectual abilities, academic performance, and personal character. At least one of these two letters should be by
someone from industry who is familiar with your professional achievements.
Recommender 1 Recommender 2
Name Click here to enter text. Click here to enter text.
Click here to enter text. Click here to enter text.
Complete address
Organization Click here to enter text. Click here to enter text.
Relationship with applicant Click here to enter text. Click here to enter text.
Email Click here to enter text. Click here to enter text.
Mobile Click here to enter text. Click here to enter text.
Phone Click here to enter text. Click here to enter text.
Fax Click here to enter text. Click here to enter text.

APPLICATION SUBMISSION
Please send the completely filled in application form along with two recommendation letters, required
documents if any, and application fee, in the form of Demand Draft drawn in favor of NITIE, Mumbai payable
at Mumbai, India, to the following address, preferably by SPEED POST:

VLFM Office
C/O SRIC Office
Administrative Building
NITIE, Vihar lake Road
Mumbai 400087
 E-Mail: vlfm.office[at]nitie.ac.in

The completed application form in all aspects along with DD / online payment details in hard copy and
email in pdf format should reach NITIE, Mumbai by 8th MAY, 2017.

DECLARATION

I certify that the information provided here is true and complete to the best of my knowledge. If this
application leads to an offer of admission, I understand that false or misleading information may
result in the cancellation of my candidature.

Name of Candidate First name, middle Signature Place-Click here to Date:

name, last name. enter text.

Email Ids
Last Date of Submission
PLEASE NOTE
For Admission related query, candidates vlfm.office[at] nitie.ac.in
correspondence and program related doubts
For letter of recommendation and sponsorship vlfm@nitie.ac.in
communication
Wrongly communicated email may delay responses.
8th May 2017
 CHECK LIST
Sr. No
Application form is duly filled
Self-attested copies of all academic, career, awards credentials
Self-attested copy of passport is attached
Online payment/ DD details are correctly filled
Self-attested recent pay slip is attached
Sponsorship letter (in case of sponsored candidates)