Online PGDM (2014 -16) Registration Form This is an automated email KIAMS Application No. 5372 Name of the Applicant (in full and in block letters):BINDU N E Father's Name EREGOWDA N V Occupation AGRICULTURE Mother's Name MANJULA HOME MAKER Occupation CAT: Reg No: SR 9246110 XAT ID: CMAT Roll No: CMAT Roll No: MAT Roll No: MAT Form No: GMAT Roll No: Gender M/F : Date Of Birth Day : 10 Month : 9 Year : 1992 Age : 21 female : Address for Communication : C-1607,BRIGADE METROPOLIS,GARUDACHAR PALYA ,MAHADEVPURA POST. Permanent Address : #6,7TH CROSS,1ST MAIN SARASWATHIPURAM City : Bangalore City : MYSORE State : Karnataka State : Karnataka Pin : 570048 Pin : 570009 Telephone No: (including STD Code): 08042010665 Telephone No: (including STD Code): Mobile No :9945469225 Mobile No : 9945469225 Caste : VOKKALIGA Religion : HINDU Email Id: (Registered with CAT/XAT/CMAT ) : [email protected] Academic Details School/College/University Specify CBSE/ICSE/State/Others Examination Name of the Degree Marks (%) / Grade Point 10th / Matriculation CHRIST THE KING CONVENT SSLC 81.6 12th / PUC or equivalen MMK SDM PUC 73.3 Bachelor's Degree (If not yet completed give latest Marks & date of completion) MMK SDM BBM 74.5 Specialization / Major Subjects Year of Passing 2008 2010 FINANCE 2013 Any other Qualification/s Work Experience No If Yes, Number of Months : Details of Work Experience (if applicable) Name of the Company/Organisation Details of work experience Employment from & to date Designation Responsibilities From : To : From : To : Past Achievements: Please list a max of five of your achievements.(academic, non academic, personal, etc.) Attach extra sheet if applicable. Sr. No Achievements 1 I had participated in inter college fest won 1st prize in an ice breaker event. 2 participated in college level fest won 2nd prize in HR event. 3 I had been part of the fund raising teams for poor people in seventh standard and had secured a gold coin 4 5 Your Preference of Centre for Group Work / Interview (please tick any one) : Bangalore Students would be called for GDPI at their preferred centers. In case of less no of students opts for any location, Admission Dept. has right to cancel/change the location. Preference of Study Campus (Rank in order of preference) : Harihar1 I confirm that to the best of my knowledge the information contained in this application is true and accurate. I have gone through the contents of the Prospectus and agree to all the conditions stipulated therein and if admitted, will also abide by the rules and regulations of KIAMS as may be in force from time to time. Date : 2014-01-19 Place : BANGALORE Signature of Applicant Please send the completed application form by Courier/ Speed Post /Regd. Post to the following address along with a DD of ? 400 in favor of Kirloskar Institute of Advanced Management Studies payable at Harihar/Davangere. Also send a self attested copy of your CAT/XAT/MAT/CMAT/GMAT score card(downloaded copy from the Internet / Photocopy) after getting the results. The Office In - Charge Admissions KIRLOSKAR INSTITUTE OF ADVANCED MANAGEMENT STUDIES Yantrapur P.O., HARIHAR – 577 601(Karnataka – India) Telephone :(08192) 241269, 241483, 241486 Fax : (08192) 241270 E - mail : [email protected], Visit: www.kiams.ac.in for detailed information