NEHRU INSTITUTE OF MANAGEMENT STUDIES [IS O 9001 : 2008 C ertified, A pproved by A IC T E , New Delhi & A ffiliated to A nna Univers ity, C hennai]

Sponsored by Nehru College of Educational & Charitable Trust, Coimbatore - 641 105.

A P P L IC AT IO N F O R MNo. :

1. a. Name : Mr./Miss/ :(In Capitals)

b. Sex : Male / Female

2. Address for communication : ..............................................................................(with pin code)

..............................................................................

: ..............................................................................

3. Father’s Name : ...............................................................................................................

4. Mother’s Name : ...............................................................................................................

5. (a)Address of Parent / Guardian : ...............................................................................................................

(b) Occupation : ...............................................................................................................

(c)Annual Income : ...............................................................................................................

6. Date of Birth :

Telephone No.

7. Nationality / Mother Tongue : ................................................................................................................

8. Native of (Place, Dist. & State) : ................................................................................................................

................................................................................................................

9. Tick the section of the community : OC BC SC ST MBC DNC

Period of Study Regular /Aggregate Year&Monthof University/Examination PrivateFrom% of Marks passing Examining Body To

Degree

Course : ••••M.B .A (Master of Business Administration) / M.C .A (Master Computer Application)

Telephone /

Mobile No.

Email ID

: ...................................................................................

: ....................................................................................

Affix Colourpassport size

photo

OB C

you belong to : Caste :

10. Academic Record(Attach attested copies)

11. Extra Curricular activities, if any :

12. Do You require Hostel facilities : Yes / No

13. Entrance Examination : MAT / CAT / TANCET / CETScore :

: ................................................................................................................

12. Registration Fee Rs. 250.00(Mention D.D./M.O Receipt No./Cash :

College Name : Tel. No. :

14. Joint declaration by the student and the parent

a) I declare that the statements given above are true and correct.

b) I have gone through the prospectus thoroughly, the prospectus was read and explained to us including the rules, regulations,course details, recongnitions, fees details, examination, board / University details, hostel mess rules, all other contentsgiven in the prospectus, information bulletin and on both sides of the application for admission.

c) I shall pay all my dues in time and shall not claim any refund for any reason whatsoever. I know any fees / charges / dues /fines paid by me are neither refundable nor transferable. In case I am forced to discontinue for any reason, after payingfull / part of admission fee / or any charges to the College, I know that I have to pay the balance of fees of course. I know onceif I join the College, I have to pay the entire fee of the course, for which I have joined, whether I study or discontinue the studies,at any time, for any reason.

d) I know that I have to pay all my fees / dues / other charges in time, otherwise I have to pay fines as fixed by he College also know thathostel rent and mess charges, as applicable, are to be paid, if I am residing in the College hostel. I have to pay the full hostel rent forthe Semester even if I stay for one day.

e) I also know that all Original Certificates are to be deposited with the College and it will be returned only after the completion ofcourse and after full payment to the course fees / dues.

f) I / We hereby agree to receive SMS and Email in connection with admission and other activities.

Place : COIMBATORE

Date :

........................................................... .................................................................. Signature of Parent / Guardian Signature of Applicant