JANKIDEVI BAJAJ INSTITUTE OF MANAGEMENT STUDIES

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					     JANKIDEVI BAJAJ INSTITUTE OF MANAGEMENT STUDIES
            SHREEMATI NATHIBAI DAMODAR THACKERSEY WOMEN’S UNIVERSITY
                                     Juhu Road, Santacruz (West), Mumbai – 400 049.
                            APPLICATION FORM – DEGREE COURSES (20                   -20                                  )
                                Please read the information before you fill up the form


1.    I Wish to apply for MBA- RETAIL MANAGEMENT                                        MBA - EXECUTIVE
       (Please tick only one)                                                                                                      Please affix
      MPMIR                                                              PG DIPLOMA IN ENVIRONMENT                                      a
      (HR – SPECILIZATION)                                                     MANAGEMENT                                       recent photograph
                                                                                                                                       here
2.    I have graduated from a University in MAHARASHTRA                             1           OTH. STATES

3.    Name of the student : __________________________________________________________________________________
      In CAPITAL LETTERS                       SURNAME                                  NAME                        FATHER’S/HUSBAND’s NAME
      (Please refer to instruction 1 and 2 overleaf).
4.    Local Address: _               ___________________________________ _________________________________________
      ___________________________________________________________________________
      PIN                                                                               Telephone No.

      E-mail: _____________________________________________________________________________________________________

5.    Permanent Address: _______________________________________________________________________________________
      __________________________________________________________________ _____                             PIN

6.    Date of Birth                          Day                            Month                          Year

7. Do you belong to
      (Please tick appropriate category)               SC         ST   DT     OBC       NT      OPEN

                                                                                    1

8. Marital Status:               1               Married                                2           Unmarried

9. Details about Examinations passed:
           Examination                      Board / University          Year of             Total Marks obtained                    Subjects
         (H.S.C onwards)                                                Passing         Actual Out of    Percentage                 Selected




10. Details of educational qualifications: (* Please fill up the appropriate Number from the list given below)
      *Code No.                                                                                *Code No.
                          1                                                                                     2
      M.Sc.; M.A.; M.Com.                  1                                                   Major Subjects at degree level
      B.Sc.                                2                                                   i)      Mathematics
      B.Com                                3                                                           Physics or                   1
      B.A                                  4                                                           Statistics
      MMs, PGDCSA                          5                                                   ii)     Any Other                    2
      Any Other                            6

11. Do you need hostel accommodation?
(If, yes, please collect a separate FORM from Hostel and apply)         Yes                                No


12. CST SCORE** (For MCIM and MeB only)                                                                               Marks out
                                                                                               Paper                                    Percentage
                                                                                                                        of 75
                                                                        GA: General Aptitude
                                                                        CC: Computer Concepts
                                                                        Overall in GA & CC
13. CET Score*                             out of 240 (For MPMIR only)

    Mother Tongue ______________________________________________________________________________________________
14. Name and Office address of
    Father/Guardian/Husband____________________________________________________________________________________
    _____________________________________________________________________________________________________________


    PIN                                                                  Telephone No.

15. Additional information – Please specify:

    (a) Academic
        achievements:__________________________________________________________________________________________

    (b) Co-curricular achievements: ____________________________________________________________________________
        (Like Sports, NCC, etc.)

    (c) Any Other _______________________________________________________________________________________________



            I have read all the instruction and information given in the Prospectus and in the Form. If admitted, I
    hereby agree to conform to all rules and regulations which are in force at present or which may hereafter be
    made by the University/Department.

                 I declare that the particulars given above are correct.
                                                                                                    Yours faithfully,



    Date:                                                                                      Signature of the Student

                                                    Instruction for the Applicant

            1.    The forms are not transferable.
            2.    Form where the name of the candidate seeking admission varies from the name appearing on the challan used for
                  making payment to obtain the prospectus/application form will be treated as invalid and will not be considered for
                  the purpose of admission. No further queries will be entertained in this regard.
            3.    Incomplete form will not be considered.
            4.    Please attach an attested copy of your CST / CET score card.
            5.    Please attach a certified True Copy of statement of marks of last qualified examination.
            6.    Please attach copies of Merit Certified / Co-Curricular achievements, etc. If any.
            7.    Applications belonging to reserved categories must attach an attested copy of the caste certificate.
            8.    A candidate belonging to OBC must attach attested copy of the Non-Creamy Layer Certified for the current year.



                                                         FOR OFFICE USE ONLY

    Certificates verified by : ____________________________________________________________

    Admitted by                   : ____________________________________________________________

    Date of Admission             : ____________________________________________________________

    Transferred by                : ____________________________________________________________

    Date of Transfer              : _____________________________________________________________

    Cancelled by                  : _____________________________________________________________

    Date of Cancellation          : _____________________________________________________________

				
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