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INFORMATION FOR IDENTITY CARD

PONDICHERRY UNIVERSITY AND ST. XAVIER'S COLLEGE
TWINNING PROGRAMME
30, MOTHER TERESA SARANI ( PARK STREET ), AFIX
STAMP SIZE
KOLKATA - 700016 PHOTO
PHONE : 033 2255 1236 WEBSITE : www.sxccal.edu

COURSE NAME : MBA SIGNATURE OF STUDENT

SPECIALIZATION : MARKETING (36) FINANCE (37) INTERNATIONAL BUSINESS (38)

( give tick mark ) HUMAN RESOURCE MANAGEMENT (39) GENERAL (43)

2017 - 2019
COURSE DURATION : …………………………… Session : ……………………………………….

ENROLLMENT NUMBER : …………………………………………………………………………..

I declare that the below mentioned information regarding me are true and upto-date :

NAME OF THE CANDIDATE : ………………………………………………………………………..

DATE OF BIRTH ( DD/MM/YYYY ) : ………………………………………………………………

BLOOD GROUP : ………………………………………………………………………………………..

PERMANENT ADDRESS : ……………………………………………………………………………

…………………………………………………………………………………………………………………….

CITY : ……………………. PIN CODE : ……………. STATE : ………………………………..

COUNTRY : ……………… RESIDENTIAL STATUS : Ordinary Not-Ordinary NRI

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HOME PHONE NO. : ……………………….. MOBILE NO. : …………………………………….

CONTACT NO. OF PARENT / GURDIAN : …………………………………………………………..

( EMERGENCY PURPOSE )

E-MAIL ID OF CANDIDATE : ……………………………………………………………………….

PARENT'S OR GURDIAN'S NAME : …………………………………………………………….

FOR OFFICE USE ONLY :

ENROLLMENT NUMBER OF CANDIATE : ………………………………………………………

VERIFIED BY ( with date ) : ……………………………………………………………………….