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NATIONAL INSTITUTE OF BANK MANAGEMENT
NIBM Post Office, Kondhwe Khurd, Pune 411 048
Tel : 020-26716000 (EPABX) Fax : 020-26834478 e-mail : pgdm@nibmindia.org
Website : www.nibmindia.org
APPLICATION FORM
POST GRADUATE DIPLOMA IN MANAGEMENT (BANKING & FINANCIAL SERVICES)
(Session Beginning 2014)
AICTE Recognized
Please read the instructions (given on the back of this form) carefully before filling-up this application form.
Affix
Photograph of
4 cms x 3.5 cms
A. Personal Information
First Name (Mr/Ms.)
Middle Name
Last Name
Date of Birth
DD MM YY
Please tick mark () Female Male Married Single
Please tick mark () Whether you belong to SC/ST/OBC/Others
SC ST OBC Others
Fathers Name :
Occupation :
Telephone No. :
E-mail :
Mobile No. :
Mailing Address
House No./Area/
Locality/Street/
City
State
Pin Code
STD Code & Tel. No.
E-mail
Mobile Alternate E-mail
2
E. Academic Qualifications
Qualification Name of the Institution/ Name of the Year of Marks (%)/CGPA
Professional Body State/UT Board/ Completion* (max/obtained)
University
Secondary
School (X)
Sr. Secondary
School (XII)
Graduate
Degree with Stream
B. Qualifying Examinations
As it appears in your CAT voucher/ATMA registration form/CMAT voucher
Examination Registration No. Percentile/Score/Rank Valid Till mm/yy
CAT 2013
ATMA (Feb. 16, 2014 only)
CMAT 2014-15
(Please attach a photo copy of the admit card of CAT/ATMA/CMAT. Score card may be enclosed if result is declared)
C. NEFT/Demand Draft Details
Remitters Name: UTR No. Date of Remittance
(Please attach scan copy of the NEFT).
Name of the Bank DD No. DD Date
D. Preferred PGPBF Interview Centres, viz. Pune/Mumbai/Delhi/Kolkata/Bengaluru/Lucknow
(Centres other than Pune are tentative)
First Preference
Second Preference
* (Please mention final year of completion only. Otherwise write appearing)
Post-Graduate
Degree with Stream
Professional 1.
Degrees/ 2.
Diploma/ 3.
Certificate 4.
Marks (%)/CGPA Marks (%)/CGPA
(max/obtained) (max/obtained)
Semester 1
Semester 2
Semester 3
Semester 4
Semester 5
Semester 6
Semester 7
Semester 8
Semester 1
Semester 2
Semester 3
Semester 4
Marks (%)/CGPA Marks (%)/CGPA
(max/obtained) (max/obtained)
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I. Declaration
All entries made in this application form are true to the best of my knowledge and belief. I am willing to
produce original certificates in support thereof if asked to do so at any stage. Admission can be cancelled at
any stage, if any information given is found to be incorrect.
Place ______________________________
Date _______________________________
G. Academic/Professional Awards/Medals/Prizes/Scholarships/Certificates/Honours, etc
(Excluding those for extra-curricular activities)
Name of the Award Awarding Institution Level Basis of Award Year
H. Major Extra-Curricular Activities/Hobbies at School/College/University
Activity Role Level
Year
Honours, if any Remarks
From To
1.
2.
3.
4.
(Please see overleaf for Instructions for Filling the Application Form)
Signature
F. Work Experience [Furnish details of jobs starting with latest/current job first]
Organization Designation Nature of Designation of Experience
Name Duties Last Person in Years &
Reporting to Months
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Instructions for Filling the Application Form
(a) Fill in the application form in CAPITAL letters with pen. Complete all items relevant to you. Incomplete
applications will be rejected. Any mistakes and/or loss on account of wrong and/or illegible entries are
the sole responsibility of the applicant.
(b) Mention your name (as it appears in the CAT/ATMA/CMAT voucher) and CAT/ATMA/CMAT
Registration number in the NIBM Application Form.
(c) Please paste your photograph in the appropriate space provided, do not staple it.
(d) CAT/ATMA/CMAT applicant should make sure to enclose a photo copy of the CAT/ATMA/CMAT
admit card with this application form.
(e) Candidates appearing for the final year bachelors degree/equivalent qualification examination and those
who have completed degree requirement and are awaiting results must attach photocopy of the certificate
from the Principal/Head of the Department/Registrar/Director of the University/Institution certifying
that the candidate is currently in the final year/is awaiting final results and has obtained at least 50%
marks or equivalent based on the latest available grades/marks. If admitted, admission of such candidates
will be provisional and subject to their completion of all the eligibility requirements of the Programme
mentioned in the prospectus.
(f) Please do not enclose any testimonials along with the form. All certificates (original) should be produced
at the time of the interview.
(g) The filled-in application form should be accompanied with a payment of Rs 1250. The amount may
preferably be transferred by RTGS/NEFT/ECS to our A/c No. 20002403044 with Bank of Maharashtra,
NIBM branch, Pune (IFSC Code MAHB0001124). For all electronic remittances, kindly send a confirmatory
e-mail at: pgdm@nibmindia.org giving details of the remitters name, UTR No., date of remittance and
scan copy of the NEFT. In case, the amount is remitted by demand draft, it should be made in favour of
'National Institute of Bank Management', drawn on any Bank and payable at Pune. The remittence and
the filled-in application form should reach The Dean (E) & Principal of the Institute before February 15,
2014. A copy of the Prospectus will be sent subsequently.
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