Course Registration/Nomination Form Two Year MBA in Transport and Logistics Management
Please return the completed form to : INDIAN MARITIME UNIVERSITY, East Coast Road, Uthandi, Chennai 600 119 Latest By………….. Phone: 044 24530343/24530345, Marine Office: 044 24530341, Fax: 044 24530342 Email: campus.imu@nic.in Website: www.imu.tn.nic.in
To be filled by the Candidate
A. Biographical Information
Name (In Capital Letters) _______________________________________________
Affix a recent passport size photograph here
Male
Female
Age
yrs
Date of Birth_____________
Designation (if any) ______________________________________ Organization ______________________________________ Address of Communication __________________________________ (Permanent & Temporary) ____________________________________________________________ ____________________________________________________________________________________ City ______________________ Fax ______________________ Phone (O) _________________________ Mobile ___________________________ (R) _____________________________ Email ___________________________________________ PIN
B. Academic Background Sr.No College/ Institution University Exam/Degree Principal Subjects Taken Grade /Marks (%)
1
Country, State, City
Medium of Instruction
Area of Specialization
2
Country, State, City
Medium of Instruction
Area of Specialization
Sr.No
College/ Institution
University
Exam/Degree
Principal Subjects Taken
Grade /Marks (%)
3
Country, State, City
Medium of Instruction
Area of Specialization
*Transcripts for each entry may be required to be produced at the time of interview
C. Description of Responsibility (if any)
Rank : ________________________
Certificate of Competency Sea Service
CDC No: _________________________
b) Number _________________________
a) Grade ________________ Month(s)______
Year(s) ______
Day(s) ______
Other Ranks ________________________________________________
D. Appearance in CAT/MAT/GMAT/IMU Entrance a) Year b) Score _____________________________ _____________________________
Candidate’s Statement of Integrity I hereby certify that I have provided accurate information in this application. I authorize IMU to verify my credentials. I understand that any misrepresentation or omission of facts in my application may justify denial or cancellation of admission from the Two Year MBA in Transport and Logistics Management. I agree that the fees once paid shall not be refunded under any circumstances.
Litigation Any dispute arising out shall be deemed to have arisen at Chennai and only Courts in Chennai shall have jurisdiction to determine the same.
SIGNATURE OF APPLICANT
Note: The Indian Maritime University reserves the right to amend, revise, reschedule or postpone classes, revise materials and examining methods
For Office Use Only This information furnished above is verified with original documents produced and found in order. (The Candidate is suitable for admission as per entry standards.) The Candidate is admitted for the above course. DEALING ASSISTANT COURSE OFFICER
Date ___________________
Signature_________________
Course Fee Payment Details
Amount Paid Rs
Mode of Payment (Cash/DD No & Date)
Receipt No & Date Signature