THE SOUTH INDIAN EDUCATION SOCIETY S.I.E.S. College of

							                                                                                              PM :
                                    THE SOUTH INDIAN EDUCATION SOCIETY

                                    S.I.E.S. College of Management Studies
                                    Sri. Chandrasekarendra Saraswathy Vidyapuram
                                    Plot No. 1-E, Sector V, Nerul, Navi Mumbai – 400 706.
                                    Tel. No: 2770 8373/76/77       Fax: 2770 8379
                                    E-mail : admission@siescoms.edu Website : www.siescoms.edu


                          APPLICATION FOR ADMISSION TO
                       PGDM (PHARMACEUTICAL MANAGEMENT)                               PHOTO
                                PGDM (Pharmaceutical Management)
                                          2008 – 2010

A. BACKGROUND INFORMATION

1. Name
   ( as it appears in
   the final year marksheet )

                                D        D      M        M            Y       E   A     R
2. Date of Birth
                                                                      1       9

3. Sex                                                    4.     Marital Status

5a. Nationality                                           5b. Category


6. Mother Tongue


7. Local Residential
   Address for
   Correspondence




8. Tel & Mob Number                                            9. Email

10. Permanent Address



11. (a) Name of Parent /
        Guardian

                                STD Code      Number
   (b) Tele & Mob No.
     12.    Occupation (Tick wherever applicable)
            a) Service

               Details        1) Designation

                              2) Organisation with which working

                              3) Contact Email id

            b) Business

               Details        1) Name of company

                              2) Turn over

                              3) Contact Email id


            c) If any other please give details

                              1) Nature of assignment

                              2) Name of the company / Profession

                              3) Contact Email id


      13.     Have you appeared for any All India Competitive Tests                   Yes        No


      14. Preferred centre of admission process.*
          (Please tick if applicable)
          (i) Mumbai
             (ii) Delhi
            * Please note that admission process will be held in a centre only if the number of candidates is more than 10.
B.     ACADEMIC QUALIFICATIONS
                               Degree & Name                                                                   Class and
       Examination                                     Board / University          Month and Year
                                of Institution /                                                             Percentage of
                                                                                     of Passing
                                    College                                                                     Marks
            S.S.C

            H.S.C

  Bachelor’s Degree                                                                                        1st yr
     Bachelor’s
       Degree                                                                                              2nd yr
 (Mention Degree)\                                                                                         3rd yr

     Other Degrees /
       Diplomas /
      Certificates
C.     WORK EXPERIENCE

         Name of the                            Tenure                      No. of Months                Position Held
         Organization                   From                To.               Worked




D.     PERSONAL DETAILS
       (i)   Mention your hobbies / interest
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       (ii) Narrate your academic achievements
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     (iii) Describe the extra-curricular activities you have participated and achievements therein
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       (iv) State three of your strengths and weaknesses

      Strengths:
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      Weaknesses:
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      (v) State, in not more than 5 lines, why you want to join the program
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E.   ENCLOSURES
     (i) Proof of age (Date of birth certificate / SSC certificate /            - Attested xerox copy
            School leaving certificate)
     (ii) Marks sheet & passing certificate of SSC, HSC & Degree                - Attested xerox copy
            examination passed. Students awaiting final year result
            should submit marksheet of all earlier years.
     (iii) Score card of competitive test                                       - Attested xerox copy
     (iv) Work experience certificate                                           - Attested xerox copy
     (v) Photo (One additional copy)
     (vi) Demand draft for Rs.              ( non refundable)
            DD No. _______________dated ________________ for Rs. ______________________
            drawn on (Bank) ________________________________Branch ___________________
      (vii) One self addressed envelope of size 10” x 13”cm
            All the particulars provided above are true to the best of my knowledge.

     Place:
     Date :                                                               Signature :       ----------------------------------
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                                        FOR OFFICE USE ONLY
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     Admission Process on :
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     * NOTE : All disputes in the jurisdiction of Mumbai.