First Name

Permanent Address

Mobile No.
Email Id

Father Name:

Father's Mobile No.:

Last Name

Date of Birth

Course Applied

MBA

Category

SC ST OBC GENERAL

Gender:

Male Female

Hostel Accommodation Required

Yes No

Qualification

Name of Examination Board/University/Institute Year of passing % Marks obtained Main Subjects
Name of Examination
High School
Board/University/Institute Year of passing % Marks obtained Main Subjects
Name of Examination
Intermediate(10+2)
Board/University/Institute Year of passing % Marks obtained Main Subjects
Name of Examination
Graduation
Board/University/Institute Year of passing % Marks obtained Main Subjects

Examination Details

CAT Roll No. Score Percentile
MAT Roll No. Score Percentile
UPSEE Roll No. Score Percentile
OTHERS Roll No. Score Percentile

Professional Qualification Experience & Company Name

Period(in Years) Name of the Company Position Responsibilty
Period(in Years) Name of the Company Position Responsibilty
Period(in Years) Name of the Company Position Responsibilty

How did you find out about Jaipuria Institute of Management, Indirapuram Ghaziabad. Please specify the source.

Alumni: Newspaper:
Friend/Relative/Parent: Magazine:
Website: Facebook/Google:
Coaching/Institute: Other(s), Pls. specify:
Hobbies & Extra-curricular activities

Declaration

I hereby declare that the information given in the Application form is true to the best of my knowledge and belief. If any information is found to be wrong, i shall be liable for action. I hold myself responsble for the due and prompt payment of fees.

Security code

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