app mba
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8/14/2019 App Mba
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E-mail : [email protected], website : www.shridevieducation.orgPh.: 91-0816-2212629, 2212627, 2211066, 2273610, Fax : 0816-2212629,
Sh r i d ev i I n s t i t u t e o f Enginee r ing & Tec hno logy
SRI SHRIDEVI CHARITABLE TRUST (R)
Affiliated to Visvesvaraya Technological University & Approved by AICTE,New Delhi Vide 06/06/KTK/ENGG/02/017 Dt. 27-05-2002
S i r a R o a d , T U M K U R - 5 7 2 1 0 6 . K A R N A T A K A , I N D I Ai ri r a R oR o a d ,d , T UT U M KK U RR -- 5 75 7 2 1 0 61 0 6 . K A RK A R N A T A KA T A K A , , I N D I AI N D I ASira Road, Tumkur-572106, Karnataka, India
COURSE INSTITUTION YEAR OF PASSINGAGGREGATE %
APPLICATION FORM - MBA No.
AffixLatest Passport Size
Photograph.Do not Staple / Pin
the Photograph(Photograph not to be
attested)
Name :
Name as entered in SSLC
Father's /Guardian Name :
Communication Address with Phone No. & PIN Code :
Date of Birth Age Sex M F
Nationality Religion Caste
Sub Caste(If any)
Category
(Signature of the Candidate)
Income. p.a
Details of Qualifying Examinations
Name of the School / College last attended
Highest Examination Passed
Name of the University / Board last studied
STSC OBC
Occupation of Father / Guardian : Govt. / Private / Self Employed / Any others specify(If Parent is not alive)
Branch: MBA
Permanent Address with Phone No. & PIN Code :
10th Standard
12th Standard
U.G.
Other Diploma if anyOthers
UNIVERSITY / BOARD
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Are the following copies of the certificates enclosed
YES / NOYES / NOYES / NOYES / NOYES / NO
YES / NO
Note : Originals of the above shall be produced at the time of admission without which the admission is not complete
Extra Curricular Activities(Enclose Certificate Copies)
Admn. Order No.:
Date of Issue:
DECLARATION1. I do here by declare that the above information is correct.2. I promise to abide by the rules and regulations of the college / institution and to the subject to their disciplinary action
and if needed, I may be removed from the college in case of persistent break of disciplinary rules.3. I understand original Certificates have to be submitted to Shridevi Institute of Engineering and Technology and these
certificates will not be returned by Shridevi Institute of Engineering and Technology unless my full tuition fee is paid andall my dues are cleared.
4. I understand all the information concerned on conducting the course will be communicated through verificationsdisplayed on the college notice board and no individual communication will be sent.
5. I shall not indulge myself in ragging in any form.
6. If admitted to Shridevi Institute of Engineering and Technology, I agree to abide by the polices, rules, laws andregulations of the college as modified from time to time.
Date :Place :
Signature of th e Candidate
DECLARATION BY THE PARENT / GUARDIANI certify that the above particulars furnished by my son / daughter / ward are correct and I undertake for the good conductand to educate my son / daughter / ward in your institute till the completion of the M.B.A. course. I shall be responsiblefor the payment of all his / her dues, if any to the Govt. of Karnataka / University / Institution.
Date :Place :
Signature of t he Parent / Guardian
FOR OFFICE USE ONLY
Branch :
Amount Paid in PGCET/KMAT/MAT Rs. ............................................................
Amount Paid in SIET Rs.
................................
................................................
Admission : Granted / Rejected
Category:
UG Reg. No.:
OFFICE SUPERINTENDENT PRINCIPAL
Admission : ................................ No. : ................................
Date ................................
Receipt No. ..................... Date ................................
PGCET/KMAT/MAT NO: PGCET/KMAT/MAT RANK:
a) SSLC / SSC / Xth Std.b) Marks card P.U. Course / Intermediate /
e) Transfer Certificatef) Character & Conduct Certificateg) Migration Certificate
h) Eligibility Certificate
c) U.G.d) Other Diploma if any
YES / NOYES / NO