Indian Institute of Management Kashipur Post Graduate Programme in Management

Application form for MBA 2020-22 for NRI/Foreign candidates

Instructions

1. Complete and accurate responses to the items are extremely important. Incomplete or false information will adverselyaffect your chances of selection. Admission granted on the basis of inaccurate information would be ipso facto null and void.

2. In all matters relating to admission to the programme, the decision of the Institute will be final and binding on the applicant. Nocorrespondence will be entertained from the applicants regarding his/her non-selection.

SECTION I:

PERSONAL DATA Please give your complete mailing address valid till July 2020

Name ….………………………………………………………………………………………………………………………………………………………………………………………………

CAT/GMAT Regn. No & Year …………………………………………………………………CAT/GMAT Score…………………………………………Address …………………………………………………………………………………………………………….

…………………………………………………………………………………………………………

………………………………………………… ……………………………………………………..

Phone No. ………………………… City Code ………………… Country Code …………………………

Email ………………………………………………………………………………………………………………….

Category: Gen SC ST OBC

Gender: Male Female

Affix your RECENT passportsize photograph here

Day

Date of birth Age as on 30th June, 2020 (in completed years) Years

Details of Passport: Country and Place of Issuance ……………………………………………………………………………………………………………..

Date of Issuance ……………………………………………… Valid up to ……………………………………………………………….

Country of Residence: …………………………………………………………………………… Date from ………………………………To……………………………..

Nationality:………………………………………………………………………………………….. Passport No:…………………………………………………………..

SECTION 2: ACADEMIC RECORD

(A) Schooling

Standard Board/University YearClass/ Division

% of MarksObtained

10th

11th

12th

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Month Year

(B) Graduation

Arts Science Commerce Engg. Others

Discipline

Subject:………………………………………………………………………………….

College ……………………………………………………………………………………..

University ……………………………………………………………………………………

Year of examination Maximum Marks/GPA Marks Obtained/GPA1st Year 2nd Year 3rd Year 4th Year 5th Year

(C) Post Graduation/Professional Qualification

Post Graduation Professional

Arts Science Commerce Engg. Others C A ICWA Others

Discipline

Subject ………………………………………………………………………………………. …………..

College/Institute ……………………………………………………………………………………..

University ……………………………………………………………………………………………….

Year of Examination Max. Marks/ GPA Marks Obtained/ GPA1st Year

2nd Year

3rd Year (if any)

SECTION 3: (A) EMPLOYMENT DETAILS

(Do not include training or project work done as part of any curricular requirement)

Organisation Your DesignationFrom To Number of

Months

Gross Monthly Remuneration

(Rs)

Designation of Person last reported toMonth/Year Month/year

Total Relevant work experience in months as on June 30, 2020 Months

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Page 3 of 4

Describe briefly your current or most recent job responsibility. State the knowledge and skills you have acquired from this experience.

SECTION 4 : CAREER PLANS

1. Why do you wish to go in for a management career?

2. What alternative careers are you considering and why?

3. Describe your strengths and weaknesses as identified by you.

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4. What is your most significant accomplishment so far?

SECTION 5 : EXTRA CURRICULAR ACTIVITIES

1. What are your achievements in extra curricular activities since college level?

a) Sports :

b) Organisational :

c) Cultural/Social :

2. What are your present hobbies?

Enclose the following with this application:

1. (a) CAT/GMAT Score card and Official NRI Status Certificate, in case you are an NRI candidate(b) CAT/GMAT score cards, and Passport/Travel document in case you are a foreign candidate

2. Completed Letters of recommendation (three numbers)

D E C L A R A T I O N

I certify that the information I have provided here is true and correct to the best of my knowledge. I agree to abide by the decision of the IIM Kashipur on all matters (including the outcome of the selection process) relating to my application for admission to the Post Graduate Programme in Management (PGP).

Date ……………………………………..

Place ……………………………………. Signature ……………………………………………………………….