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Form No: 50823

INSTITUTE OF RURAL MANAGEMENT ANAND


Written Test Application Form 2010

Payment Particulars
Mode of Payment Date Amount Transaction ID.
Payment Gateway
Online ICICI 22-09-09 1000 800824728 Photo

1. Full Name of Applicant: ROHAN RAVI NAIR

2. Father's Name: RAVI

3. Address 46/104 `A` WING, MANISH NAGAR, ANDHERI(W)


MUMBAI
MAHARASHTRA
PIN: 400053
Email: rohan1509@gmail.com
Phone: 022 26372203 Mobile: 9987933943

4. Date of Birth: 15-09-1989

5. Gender: Male

6. Category: General

7. Education status: (Graduation) Appearing in the final exam / Awaiting for final year result

8. Discipline: Others

9. Percentage at Graduation: 69.73

10. Percentage at PG: N.A.

11. Choice of Test Centre: MUMBAI (No change will be allowed. Right of allocation rests with IRMA.)

12. Work Experience: 0 month(s) (as on 31-7-09)

13. Programme applied for: Only PRM

14. Sponsored Candidate?: No

15. Yearly Family Income: 3,00,001 to 4,50,000

16. State of Domicile: Maharashtra

17. Source(s) of information about admission.


IRMA Website

18. Declaration
I declare that all the information contained in this form is correct. I shall provide documentary evidence, if required, wherever applicable. I understand that, if
selected, my admission will be provisional; it will be confirmed only if I fulfil the eligibility criteria set for the admission. In the event of any false information
appearing in this form or in the event of my failure to provide necessary certificates, my admission will stand automatically cancelled.

Date: _________________ Signature of Applicant:

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