Admission Form of Executive PGDM for the year 2015-2016

VAIKUNTH MEHTA NATIONAL INSTITUTE OF CO-OPERATIVE MANAGEMENT UNIVERSITY ROAD, PUNE – 411 007.

CENTRE FOR MANAGEMENT EDUCATION

APPLICATION FORM POST-GRADUATE DIPLOMA IN MANAGEMENT- EXECUTIVE (15 MONTHS PROGRAMME) 2015-2016 BATCH (APPROVED BY THE ALL INDIA COUNCIL FOR TECHNICAL EDUCATION New Delhi)

Roll No. (to be allotted by the office)

National Level Common Entrance Test Score CAT / MAT / XAT Month & Year of Score / ATMA / CMAT Examination and (attach photocopy of score (GMAT/GRE for Validity card) Foreign Nationals (Specify)

Affix your photograph here (Passport Size)

GD & PI Centre : Group Discussion & Personal Interview in October/November 2015 at VAMNICOM, Pune

A) PERSONAL DETAILS a) Name in Full--------------------------------------------------------------------------------------------------(in CAPITAL Letters as written in SSC Certificate) b) Parent / guardian’s Name: ----------------------------------------------------------------------------------(in CAPITAL letters) c) Parent’s Occupation: ----------------------------------------------------------------------------------------d) Mailing Address ---------------------------------------------------------------------------------------------------------------------------------- PIN CODE:----------------------- MOBILE NO. :---------------------------E-MAIL: ---------------------------------------------------------- PHONE NO. : ------------------------------e) Permanent Address ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ PIN CODE:----------------------- PHONE NO.-----------------------------FAX NO. : --------------

E-MAIL: ------------------------------------- MOBILE NO. :------------------------

f) Date of Birth :

Date: ________ / Month : __________ / Year ____________

g) Gender : MALE (

) FEMALE (

) Please Tick ( )

h) Indicate the category to which you belong to – Please Tick ( ) (Attach photo copy of certificate)

SC

ST

WARD

SPONSORED

OBC(non creamy) PHYSICALLY

OTHERS CHALLENGED

EDUCATIONAL QUALIFICATIONS (Give details from 10th standard onwards)*

B)

Level of Examination

Course completed

Board/ University

Year

Maxi.

Marks

Marks Obtained

% of Marks

Class / Grade

10th Standard +2 Graduation Post Graduation Professional Qualification Note : Attach Photo Copies of Certificates and other Documents.

C)

WORK EXPERIENCE * (Attach a copy of Certificate/s) Name of the Organization

Designation

Scale / Salary drawn

Period From

To

Total Experience in Years

D)

OTHER RELEVANT INFORMATION (attach a separate sheet) Extra-curricular activities: Give details of sports, games, hobbies and other activities you consider worth mentioning including awards received, positions held in different associations etc.

E)

DECLARATION I declare that the information given by me in the application is true to the best of my knowledge.

I have read the PGDM Handbook details on the website and agree to abide by the rules and regulations of the Institute.

I hereby submit to the disciplinary jurisdiction of the authorities of the Institute and shall observe and abide by the rules laid down by the Head of the Institute. All legal disputes shall be covered under Pune jurisdiction.

Place

:

Date

: __________________________ Signature of the Applicant

Enclosure :

1. _______________________

2.

______________________

3. ________________________

4.

______________________

Attach photocopy of the following documents and bring all original documents at the time of GD & PI : 1

Score card of CAT / MAT/XAT/ATMA / CMAT

4

Caste Certificate

2

S.S. C. Certificate

5

Post-graduate Certificate, if any

3

Graduate Certificate

6

Experience Certificate/s

*Attach extra sheet if necessary.

Note: Application fee once paid will not be returned.

FOR OFFICE USE ONLY : Fee Payment details: Payment by cash Rs. 500/- vide Receipt No._______________ dt.__________ (to be filled by Office) OR Payment details of Demand Draft of Rs. 500/- in favour of “The Director, VAMNICOM, Pune” /NEFT details: Name of the Bank, Branch and IFSC Code

Demand Draft No. Date/ NEFT UTR No.

&

Amount (Rs.)

Rs. 500/- (Rs. Hundred Only)

Receipt No. & date (to be filled by Office)

Five

ADMIT CARD

VAIKUNTH MEHTA NATIONAL INSTITUTE OF COCO-OPERATIVE MANAGEMENT UNIVERSITY ROAD, PUNE – 411 007

CENTRE FOR MANAGEMENT EDUCATION (Office Copy) POST-GRADUATE DIPLOMA IN MANAGEMENT- EXECUTIVE (15 MONTHS PROGRAMME) 2015-2016 BATCH Roll No. (to be allotted by the office) Name -------------------------------------------------------------(as in application form) Address

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Centre (to be filled by office)

Date

Time

Group Discussion & Personal Interview

_______________________ Signature of the Applicant (to be signed and sent along with application form)

__________________________ SIGNATURE OF THE PROGRAMME DIRECTOR AND OFFICIAL SEAL

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VAIKUNTH MEHTA NATIONAL INSTITUTE OF COCO-OPERATIVE MANAGEMENT UNIVERSITY ROAD, ROAD, PUNE – 411 007 CENTRE FOR MANAGEMENT EDUCATION

ADMIT CARD (Candidate's Copy)

POST-GRADUATE DIPLOMA IN MANAGEMENT- EXECUTIVE (15 MONTHS PROGRAMME) 2015-2016 BATCH Roll No. (to be allotted by the office) Name ----------------------------------------------------------------------(as in application form) Address

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Centre (to be filled by office)

Date

Time

Group Discussion & Personal Interview

_______________________ Signature of the Applicant

(to be signed at the time of GD & PI)

___________________________ SIGNATURE OF THE PROGRAMME DIRECTOR AND OFFICIAL SEAL