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CSIRD-IMT
(Affiliated to Sri Krishna Devaraya University
and Approved by A.I.C.T.E.)
A CHRISTIAN MINORITY INSTITUTION
C.S.I Mission Compound, NH-63, Guntakal
Road, Gooty-515401
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APPLICATION
FOR M.B.A COURSE
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Appl.
Form No:-___________ |
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Details
of Integrated Common Entrance Test |
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| Hall
Ticket No |
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_________________ |
| Rank |
: _________________ |
| Marks
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: _________________ |
| Church
Affiliation |
: _________________ |
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Affix
Color Passport size
Photo
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| 1.
Name of the Candidate (Block Letters) |
: _____________________________ |
| 2. Father’s
Name / Guardian’s Name |
: _____________________________ |
| 3.
Date of Birth |
: _____________________________ |
4.Present
Address :
(Mention at least one telephone number)
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: _____________________________ |
| : _____________________________ |
| 5.Permanent
Address |
_____________________________ |
| _____________________________ |
| 6.Father’s/Guardian’s
Occupation |
: _____________________________ |
| 7.Father’s/Guardian’s
Yearly Income |
: _____________________________ |
8.Community (Christian
Minority/Others/
B.C-A/B.C-b/B.C-C/B.C-D) S.C., S.T.&
Others
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: _____________________________ |
| 9.Identification
Marks |
: _____________________________ |
| 10.Local/Non-Local |
: _____________________________ |
| 11.Academics |
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Optionals |
Percentage |
Year
of Passing |
Institution |
| Intermediate
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| Degree |
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| P.G.
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DELARATION BY THE CANDIDATE
I declare that all the particulars
furnished above are correct. I am fully
aware that it is a Christian Minority
Institution and admissions are only
on Qualifying ICET.I am willing to pay
the fees as prescribed by the management
on admission. I shall not claim my fees
at any time on cancellation of my admission
due to any reason. I shall abide by
the rules and regulations of the institution.
The above furnished information is true
to my conscience and if my information
is found to be incorrect, my admission
may be cancelled, I promise to put at
least 80% of attendance in every semester,
other wise I may not be sent for the
University Examination.
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| Signature of
the Parent / Guardian |
Signature
of the Candidate |
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| Date: |
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| Photo
copy of Certificates to be submitted along
with the Application Form
1. ICET Rank Card
2. ICET Hall Ticket.
3. Degree Certicate Provisional
4. Degree Consolidated Memo
5. Transfer Certificate
6. Intermediate Certificate
7. 10th Class Certificate
8. Church Affiliation Certificate
9. Migration Certificate,if other than
S.K.U
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FOR
OFFICE USE ONLY |
The
candidate is Admitted / Rejected in MBA/MCA
Course |
| Date: |
Director |
