First Name

Permanent Address

Mobile No.
Email Id

Father Name:

Father's Mobile No.:

Last Name

Date of Birth

Course Applied

MBA

Category

SCSTOBCGENERAL

Gender:

Male Female

Hostel Accommodation Required

YesNo

Qualification

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

Examination Details

CATRoll No.ScorePercentile
MATRoll No.ScorePercentile
UPSEERoll No.ScorePercentile
OTHERSRoll No.ScorePercentile

Professional Qualification Experience & Company Name

Period(in Years)Name of the CompanyPositionResponsibilty
Period(in Years)Name of the CompanyPositionResponsibilty
Period(in Years)Name of the CompanyPositionResponsibilty

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

Date