Pearl Academy

Admission 2015
Payment Mode Credit / Debit Card

Application Form Number

11143427
Programme Applied & Campus Selected

Course Category
2-Year Post Graduate Diploma / 1 year
PG Prof. Diploma
Programme Campus

1. 2 Year PG Diploma in Fashion Design [PGFD] Mumbai

2. 2 Year PG Diploma in Fashion Design [PGFD] Jaipur

Choice of Test Date

Cycle-2 : 06-06-2015
Examination Center
Nagpur

Personal Details
First Name Middle Name Last Name

Madhura Ram Daftari

Date of Birth 14-06-1995

Gender female

Blood Group O+

Nationality Indian

Email (Applicant's) madhura.daftari@gmail.com

Mobile/phone (Applicant's) 9689211342

Family Details
Father Name RAM DAFTARI Mobile No: 9423410813

Father's Occupation Retired specify: as a lecturer

Father's Annual Income(Rs. 500000 Email ID: daftariram@gmail.com

in lakhs)

Mother's Name ALKA DAFTARI Mobile No: 9422121072

Mother's Occupation Service Specify: Government

Mother's Annual Income(Rs 700000 Email ID: daftariram@gmail.com

in Lakhs )

Address Details
Present 443, HANUMAN NAGAR, NAGPUR. 440009. MAHARASHTRA.
Address
City NAGPUR State MAHARASHTRA PIN 440009

Country india Telephone No: 07122745398

(Check if same as above)

Permanant 443, HANUMAN NAGAR, NAGPUR. 440009. MAHARASHTRA.

Address

City NAGPUR State MAHARASHTRA PIN 440009

country india Telephone 07122745398

Your Mailing Address Preference : Permanent Address

Educational Details
Qualification Stream / Year of Passing Name of the Name of the %age Main Subjects
Discipline / University / College /
Specialization Board Institution

10th ssc 2010 state p.b.v.v. 84% mathematics,science,marathi

12th hsc 2012 state mohota science 71.83% physics,mathematics,chemistry,biology

college

Graduation b.sc appeared nagpur shivaji science appeared physics,mathematics,computer

college science

Post
Graduation

Masters

Extra Curricular Activities:

painting

Special Awards / Merit / Scholarships

intermediate passed with A grade

Work Experience:
Job Title Name of Details of role / From To
Nature of Work/ Training Organization responsibility

NA

Declaration by Applicant
 DECLARATION BY APPLICANT REGARDING SCORES OBTAINED IN MAT / CAT / GMAT FOR WAIVER OF
GENERAL PROFICIENCY TEST (GPT) – APPLICABLE ONLY FOR PG DIPLOMA and PROFESSIONAL DIPLOMA
APPLICANTS.

I had appeared in:

b. The minimum scores for MAT / CAT / GMAT for want of waiver of GPT only shall be as under:

• Minimum MAT score of 500 or above

• Minimum CAT score of 60 percentile or above
• Minimum GMAT score of 450 or above

PLEASE NOTE: Applicants seeking waiver of GPT are required to enclose an attested copy of the relevant valid
Score Card along with this application form. In the absence of copy of valid score card, waiver will not be accepted
and the applicant will be required to appear in the GPT. Applicants of Design stream courses, who are allowed
waiver of GPT, will be required to appear for Design Aptitude Test (DAT). Decision to grant waiver of GPT rests with
Pearl Academy of Fashion. Waiver of GPT is not automatic.

Local Guardian’s Details:

Local Guardian's Name Address

Telephone No:

Hostel Facility required YES

Payment Authorization
Application Fee: Rs:1000

Reciept No. 512321456827

Transaction No. 8072

Order Info 2577581

Payment Date 03-05-2015

Declaration of Applicant
Declaration of Applicant:I certify that the particulars furnished are true and complete in all aspects, and no information
has been withheld.I understand that falsifying documents or information on this application may result in penalties up to
and including immediate/ permanent dismissal from the Academy. I understand that misrepresentation, falsification of
documents, and/or the withholding of requested information in regard to this application are serious offences that may
result in prosecution.

I accept that no changes will be entertained once the duly filled forms have been submitted and that should my
aplication be submitted with incomplete forms it will be rejected.

Place

Date Signature of Applicante

(To be Signed Prior to dispatch)
Score Card