Final Admission Roll No.

____________ Division ______

Bharati Vidyapeeth University INSTITUTE OF MANAGEMENT & RESEARCH NEW DELHI A-4, Paschim Vihar, Rohtak Road, New Delhi 110063 Ph. 25286442 Fax 25286442

To, The Director Bharati Vidyapeeth Deemed University Institute of Management And Research A 4, Paschim Vihar Main Rohtak Road, New Delhi

Paste your recent passport size photograph

Sir, I, the undersigned Mr./ Ms. _______________________________________________ S/o / D/o _____________________________________________________ wish to seek permission to join the post graduate course MBA in your institute. I humbly and respectfully undertake that: 1. The information given by me is true to the best of my knowledge and belief. 2. I will abide by the rules and procedures of the institute and the Bharati Vidyapeeth Deemed University, Pune. 3. I am fully aware that the rules regarding fulfillment of eligibility condition for admission are binding on me. I will be held responsible for every loss including cancellation of admission coming on account of non-submission of documents, required by the University for Eligibility Purpose. 4. I will ensure 75% attendance as required by Bharati Vidyapeeth Deemed University, Pune. 5. Any kind of court disputes will be resolved in Pune Jurisdiction only. 6. I am submitting herewith (1) My brief Bio-data (2) Undertaking for Eligibility Compliance (3) Undertaking for Membership to Alumni Association (4) Undertaking for Anti Ragging (5) Undertaking in case of Cancellation and Refund of Fees Thanking you, Yours faithfully,

(Signature of Candidate)

BHARATI VIDYAPEETH UNIVERSITY INSTITUTE OF MANAGEMENT & RESEARCH , NEW DELHI-110063 AN ISO 9001: 2008 CERTIFIED INSTITUTE ADMISSION FORM Fill All the Details in Capital Letters. Student Information

PASTE YOUR COLOUR PHOTO. DON'T STAPLE.

Personal Information
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Student Name Admission Date Date Of Birth Batch Session Previous Board/ University Course Health History If Yes Specify here:Sex Religion Category Nationality Blood Group Phone No Mobile No
If Admitted under NRI / PIO Category on what basis ; Holding Foreign Nationality . Yes No

(MM-DD-YYYY Format)

Physically Challenged :

Yes

No

Male Hindu
GEN OBC

Female Jain
J&K Ex Ser.

Muslim
SC

Sikh
ST

Christian
NRI

INDIAN

if NRI Name of the Country

If Yes 17 Passport No VISA Details (Period)

Country Name :-

From : ____________________ To __________________ Yes No

Parents Working Abroad : If Yes 18 Organization Name Service (in years)

Country Name:-

Past Academic Records 1 2 3 4 5 6 7 B-MAT Rank Education School / Institute /College / Univ. Name Marks Percentage Grade Specialization** Passing Year Name of organization. 8 Any work Experience: Designation Duration. Address of company **12th like:-Science/Art/ Commerce/ other Specify ** Graduation like:- BA/B.Com/B.Sc/BBA/BCA/B.Tech/BE/ Other Specify Job Profile 10th 12th Graduation

Documents
The original (if applicable) with One Xerox copy of the following document are attached. 1.Mark sheet 4.Caste Certificate . Parent's /Gurdian Details 1 2 3 4 5 6 7 8 Father's Name Qualification Occupation Company/ Orgnization Name E-Mail ID Official Address Office Phone No. Mob_No 2.TC/character/Prov. 5.Affidavit. 3.Migration. 6.Migrant Certificate. (J&K)

Mother's Details 1 2 3 4 5 5 6 7 Mother's Name Qualification Occupation Company/ Orgnization Name E-Mail ID Official Address Office Phone No. Mob_No

PERMANENT ADDRESS 1 2 3 4 5 Address Country State City/ District Pin Code

Correspondence Address 1 2 3 4 5 Miscellaneous 1 2 3 4 5 If yes 6 Mother Tongue Place of Birth with State Marital Status Hobbies Is Punished by any Univ. / College / School Give Reason:E-Mail Id Address Country State City/ District Pin Code

Parent's Signature

Student's Signature

Bharati Vidyapeeth University INSTITUTE OF MANAGEMENT & RESEARCH NEW DELHI A-4, Paschim Vihar, Rohtak Road, New Delhi 110063 Ph. 25286442 Fax 25286442

ADMISSION 2012 13 MBA UNDERTAKING FOR NON-AVAILABILITY OF DOCUMENTS

I ___________________________________ S/O / D/O ________________________________ appeared in B MAT 2011 with Roll NO. ____________________ Rank: _______________, Category General ( ) / Mgnt. ( ) / NRI ( ) seeking admission to

___________________________ programme undertake to submit the following original documents by 25th August, 2012 failing which admission granted provisionally shall stand cancelled and I shall be cease to have any claim on it thereafter: Sr. No. 1) 2) Document Statement of Marks (Last qualifying examination) Migration Certificate from the University from which the candidate has passed the last qualifying examination Transference Certificate from the College last attended Affidavit regarding Gap in Education on Rs. 20/Stamp Paper, if applicable Cast Certificate (in case of SC /ST) Migrant Certificate (in case of Kashmiri Migrant candidate) Submitted Original) (in Not Submitted

3) 4) 5) 6)

Date

Signature of Candidate

Address of Candidate with Telephone Nos: _____________________________________ _____________________________________ _____________________________________ Tel. No.: (M) __________________________ (Landline): ____________________ Signature of Verifying Authority Name Designation

Bharati Vidyapeeth University INSTITUTE OF MANAGEMENT & RESEARCH NEW DELHI A-4, Paschim Vihar, Rohtak Road, New Delhi 110063
[

VERIFICATION SLIP ADMISSION 2011 12

(Note: To be submitted at the time of counselling / admission. Fill up the column whichever are applicable)

MBA
Name of the Candidate Address : __________________________________________________ : __________________________________________________ : __________________________________________________ __________________________________________________ Telephone No. B Mat Roll No. 1. College (last attended) : __________________________________________________ B MAT Score B MAT Rank

: ________________________________________

2. Date of Birth (As per Sr. Secondary : ________________________________________ 3. Senior Secondary Examination : Marks Obtained: ______/ ______ % (Aggr.) _____ 4. Percentage in Graduation : I Year: _______ II Year _______ III year ______ Aggregate: ________ 5. Category Certificate 6. Details of Demand Drafts a) For Submission of Fees Amount: _______________ DD No. ______________ Date: ________________ Bank Branch: _____________________________________ b) For submission of other fees Amount: _______________ DD No.: _____________ Date: _________________ Bank Branch: _____________________________________ Signature of Candidate I have carefully read and verified the information furnished by my son / daughter / ward and affirm that it is true and correct and he / she fulfills the eligibility conditions as mentioned in the Admission Brochure. Signature of the Father / Guardian Signature of Verifying Authority: __________________________ Date : __________________________ : SC / ST / Kashmiri Migrant ____________________ :

Bharati Vidyapeeth University INSTITUTE OF MANAGEMENT & RESEARCH NEW DELHI A-4, Paschim Vihar, Rohtak Road, New Delhi 110063 Ph. 25286442 Fax 25286442

Undertaking for Alumni Association UNITED BRETHREN

I _________________________________ Son / Daughter of ____________________________ resident of _____________________________________________________________________ have been provisionally admitted to Bharati Vidyapeeth University Institute of Management And Research, New Delhi in MBA programme hereby accord my consent to become a member of BVIMRs Alumni Association UNITED BRETHREN on the completion of the aforesaid programme by paying Rs. 1000/- as its Membership Fees.

I further accord my consent that the Security Money deposited by me at the time of admission at BVIMR, New Delhi be refunded after deducting Rs. 1000/- payable by me as Membership Fees of BVIMRs Alumni Association UNITED BRETHREN.

Signature of Candidate

Place : New Delhi Date : _______________________

UNDERTAKING
To, The Director Bharati Vidyapeeth University Institute of Management And Research A 4, Paschim Vihar, Main Rohtak Road New Delhi I ______________________________ S/O / D/O ___________________________ student of ________________ course of BVIMR, New Delhi have read all the rules of admission and undertake that: 1. The information given by me in my application is true to the best of my knowledge and belief 2. I have not been debarred from appearing at any examination conducted by any Government constituted or statutory autonomous examination authority of India 3. Ragging: (a) I will not indulge myself into any ragging activity, in case, I am found guilty of the same, I know, I shall be rusticated from the institute and liable for legal action as per Supreme Court Order. (b) I will submit the anti ragging affidavits (as per performa specified in Prospectus) within three days of commencement of classes. 4. I fully understand that the Director of the Institute has the right to expel, rusticate me from the institution for any infringement of the rules of good conduct and discipline in general and particularly the ones referred in prospectus and the rules of good conduct and discipline prescribed by the Institute / University. Student Signature Student Name : _____________________________________ : _____________________________________

Guardians Signature : _____________________________________ Guardians Name Course Address : _____________________________________ : _____________________________________ : _____________________________________ : _____________________________________ : _____________________________________ Phone No. Date : _____________________________________ : _____________________________________

UNDERTAKING: Refund of Fees

It is to certify that I have read and fully understood the rules of University for cancellation of admission and refund of fees etc. thereon which are reproduced below and these rules shall be abided by me. 1. In the event of a student withdrawing before the starting of the particular course, the fee collected from the student, after a deduction of the processing fee of Rs. 1000/- (Rupees one thousand only) shall be refunded. However, with respect to the grant-in-aid courses the rules prescribed by the State Government will be applicable. 2. If a student submits his application for cancellation of admission in a prescribed form (duly completed) within 15 calendar days from the date of commencement of the particular course, 10 percent of total amount of tuition fees prescribed for the course will be deducted from the amount of tuition fee paid by him and the balance amount will be refunded. 3. If a student submits his application for cancellation of admission in a prescribed form (duly completed) within 30 calendar days from the date of commencement of the particular course, 20 percent of the total amount of tuition fees prescribed for the course will be deducted from the amount of tuition fee paid by him and the balance amount will be refunded. 4. If a student submits an application for cancellation of admission after 30 calendar days from the date of commencement of the particular course, no refund will be made and Rule (5) may also be invoked. However, if the application for cancellation of admission is submitted before the last date prescribed for admission and if the vacated seat is filled by another candidate, 25% of the amount of tuition fees prescribed for the course will be deducted from the amount of tuition fee paid and the balance amount will be refunded. 5. If any student admitted to any course leaves the course after the prescribed last date for admission of the particular course, no refund will be made and he will be required to pay full amount of tuition fees for the remaining entire duration of the course. Name of candidate

Course in which admission made .

Name of parents/ guardian

Address of parent/ guardian .

Signature of parent/ guardian .

Signature of Admission Officer Along with seal of Institute

Library Card and Identity Card Application Form

Please paste your recent passport size photograph

Bharati Vidyapeeth Deemed University INSTITUTE OF MANAGEMENT & RESEARCH

A-4, Paschim Vihar, Rohtak Road, New Delhi 110063

FillupthedetailsinBLOCKLettersonly
Name of the Student Fathers Name Permanent Address : ____________________________________________________ : _____________________________________________
: _______________________________________________

______________________________________________________________________________ ______________________________________________________________________________

Residence Phone No. Date of Birth E-mail

: _______________________Mobile No.__________________ : ___________________________________________________

: ___________________________________________________ Student Signature (Please Sign in appropriate Box
only)

Signature should be black Point pen only.

ball

FOR OFFICE USE ONLY

CLASS: MBA Library Membership No. ......................................

YEAR: 2012 2014

Note: 1. Fill up the details in BLOCK Letters only. 2. E-mail ID is compulsory. 3. Please attach 02 passport size photographs for Library Cards (TOTAL: 03 Photo)