Visvesvaraya Technological University

Jnana Sangama, Belgaum - 590 018, Karnataka State

APPLICATION FORM FOR ADMISSION TO MASTER OF BUSINESS ADMINISTRATION (MBA) - 2013
(Filled Application shall be sent through mail in MS-word format only to specialofficer@vtu.ac.in) Affix Latest Color Photograph 1. 2. Entrance Test Place: Bangalore

Belgaum

Mysore

Gulbarga

Name: ___________________________________________________________ (In Block Letters) Correspondence Address: Permanent Address: _______________________________________ _______________________________________ ___________________PIN_________________

3.

_______________________________________ _______________________________________ _______________________PIN_____________ Phone (With STD Code): ______________________ Mobile Email ID 4. Date of Birth: DATE MONTH : ______________________ : ______________________

YEAR

5.

Sex: M F

(Tick in appropriate box)

6.

Nationality: _____________________

7. GM

Category: SC ST

(Tick in appropriate box)

I IIA IIB IIIA IIIB Phy.H EX- Serviceman

8. QUALIFICATION DETAILS: DEGREE: Sl.No 1 2 3 4 Particulars of the examinations passed I Year / I Semester II Semester II Year / III Semester IV Semester III Year / V Semester VI Semester IV Year/ VII Semester VIII Semester Total 9. D.D. Details: Amount: ______________ D.D. No: ______________ Date: _____________ Name of the University BRANCH / STREAM: Month & year of Passing Max. Total Marks Marks Obtained Aggregate % of Marks

Name and address of the Bank: _______________________________________________ 10. Please enclose the following in the form of attested copies Check list Yes 1. SSLC Certificate 2. PUC Certificate 3. Degree Certificate 4. Degree Marks cards of all the semesters / years 5. Certificate in support of your claim under Reservation 6. D. D. (GM-` 600/- & SC / ST / Cat-I ` 300/-, In favor of Finance Officer, VTU. Payable at Belgaum) DECLARATION 1. 2. 3. 4. I declare that I have studied minimum seven years in Karnataka. I declare that all information given by me is true and authentic to the best of my knowledge and belief. I abide by the rules and the regulations of MBA Programme of VTU, Belgaum. If I am found to be ineligible for Admission to MBA programme according to the above rules, I agree to forfeit my application and will seek no legal redressal in the matter. No

Place: Date: Signature of the Applicant

Candidate Copy

Visvesvaraya Technological University

Jnana Sangama, Belgaum - 590 018, Karnataka State
ADMISSION TO MASTER OF BUSINESS ADMINISTRATION (MBA) - 2013

Hall Ticket for VMAT- Entrance Test

Affix Latest Color Photograph

Entrance Test Number Name Test Center Date Time

: (Office use only) : : (Office use only) : 30-09-2013 : 11:00 AM to 1:00 PM

Signature of the Candidate

Signature of the Invigilator

Registrar

Visvesvaraya Technological University

Jnana Sangama, Belgaum - 590 018, Karnataka State
ADMISSION TO MASTER OF BUSINESS ADMINISTRATION (MBA) - 2013

Office C

Hall Ticket for VMAT- Entrance Test

Affix Latest Color Photograph

Entrance Test Number Name Test Center Date Time

: (Office use only) : : (Office use only) : 30-09-2013 : 11:00 AM to 1:00 PM

Signature of the Candidate

Signature of the Invigilator

Registrar