KIIT UNIVERSITY

KIIT SCHOOL OF RURAL MANAGEMENT APPLICATION FORM

MBA (RURAL MANAGEMENT) & MBA (AGRIBUSINESS MANAGEMENT)

1. Candidates Name (as given in Class X Certificate) 2. Fathers Name (as given in Class X Certificate) 3. Date of Birth 4. Sex 5. Nationality 6. State 7. Communication AddressLine 1
Line 2 Line 3 DD Male Indian MM Y Y Y Y
Paste recent Passport size Photograph Must indicate clearly the name of the candidate (4 cm x 5 cm size) (Don't staple)

Female Others

City State Phone No. (with STD Code) 8. Category 9. Course Applied 10. Exam Appeared 11.Centre (GD/PI) 12.Qualification Details Qualification (Tick any One Option) % Marks in Graduation Passing Year 13.Email - Id. 14.DD Details Drawee Bank DD Number DD Date
DD MM Y Y Y Y General

Pincode

-SC ST PH

Mobile No.

MBA (RM) IRMA

MBA (ABM) CAT XAT MAT TISS CMAT

ID / Regn. No / Roll no........................................ Composite Score / Percentile............................. Bhubaneswar

Appearing for Graduation

Passed Graduation

Passed PG

Graduation Course Name(eg. B.Sc (Agri), BE, BBA, BCA)

Paste recent Passport size Photograph Must indicate clearly the name of the candidate (4 cm x 5 cm size) (Don't staple)

Declaration: I hereby undertake that the information given through this Application form are true and correct to the best of my Knowledge.

Signature of the Father / Mother / Guardian

Left Thumb impression of the Candidate

Signature of the Candidate Date :