Application Form For PGDM 2012-14          
Instructions to the Applicant:
1.Application form should be legible filled in. Incomplete and illegible applications are liable to be rejected.
2.Once the form has been filled online, take a printout of the form and sent it to the Institute's city office address along with the enclosures given below:
    A demand draft of Rs. 750/- in favour of SRMS IBS payable at Lucknow. Write your name and application form number at the back of the demand draft
     Attested copy of degree certificates and qualifying examinations
     One Self addressed Envelop : (10x4)" with postal stamp of Rs. 27/-
     Photocopy of T.C./Migration certificate
     Photocopy of Affidavit for gap (if any gap in education)
     Photocopy of Caste Certificate
     Photocopy of Certification showing Date of Birth
     Four colour photographs (2.5" × 2")
     Attested copy of score card of Entrance Test
 
 
D.D. Number* D.D. Date* Issuing Bank and Branch* Amount in Rs.*
 
A. Applicant's Personal Details
*Name : Middle Name : * Surname :
Father's Full Name :      
*Date Of Birth :      
*Gender :        
*Permanent Address :          
*City : *State : *Upload Your Photo(1MB Limit)
*Pincode : *Mobile :
*E-mail :      
(Tick if Permanent address and Communication address are same.)
*Communication Address :            
*City : *State :      
*Pincode : *Mobile :      
*E-mail :            
B. Personal Interview
Personal Interview will be conducted in the following cities. Please tick one city of your choice.*
     
     
   
SRMS IBS reserves the right to cancel or change the interview locations at its sole discretion.Only short listed candidates shall be called for the selection process.
 
C. Academic Record
               
  Name Of Institution City/Town University/Institution Stream Degree Year of Passing(DD/MM/YY) % of Marks
Post Graduation/Others
Graduation
4th Year
3rd Year
2nd Year
1st  Year
Class XII
Class X
D. Test Score
Please attach attested copy of test score.
Test Your Score Percentile Registration No. Date Of Examination
CAT
MAT
Others(Specify)
E. Professional Certification (If Any)
Name of Certification Name of the Institution Month of Year of Certification Awards(if any)
F. Work Experience:
       
 Organisation Designation Duration Annual Renumeration Industry
from to
G. Extra Curricular Activities.
List your main activities/achievements post 10+2.*
H. Other Information
How did you first hear about SRMS IBS?
   
Name the top 3 MBA websites you consult for selecting B-schools
     
Would You Like to visit the campus?
List the other institutes(in order of importance) you have applied to for your MBA/PGDM program
 
 
 
Did you take coaching for any of the MBA entrance exam given below?  If yes ,mention.
         
What type of interaction have you had with SRMS IBS and did it encourage you to apply?
Campus visit Counselling Sessions  
Telecounselling Interaction with our Director/Faculty  
       
What is your Family's consolidated annual income?       
How would you finance your studies at SRMS IBS?         
I. Eassy Type Questions.
Answer the following questions in not more than 200 words each.
What are your goals and objectives and how will a SRMS IBS PGDM help you achieve these? Please feel free to discuss both personal and professional goals.
 
What do you consider to be your greatest skills and talents? How will you use these to contribute to your PGDM class as well as to a study group?
 
     
Describe the most significant way, either in or out of your job, that you have demonstrated leadership.
 
J. Declaration.
All dispute pertaining to matters of admission and its terms and conditions are subject to Unnao jurisdiction and no other court shall have jurisdiction in this matter.
    I hereby certify that the above information is true,to the best of my knowledge. I authorize SRMS IBS and any of its employees to use the information contained in this application in any matter it deems necessary for the purpose of admission into its program.
 
 
Date- Signature of the Candidate Signature of the Parents/Gardians