Signature of the panel members Documents Checked & Verified FOR OFFICE USE ONLY

with Date & Comments

i) DOB Form No. ..............................
ii) Management Aptitude Test taken
(CAT/MAT/XAT/ ATMA/JEMAT) Form Received on .....................
iii) Secondary Exam
iv) Higher Secondary Exam Class Roll No.............................
v) Graduation
vi) Post Graduation Date of Admission.....................
vii) Experience Certificate (if any)

INSTITUTE OF BUSINESS MANAGEMENT

(Approved by AICTE, Affiliated to Jaduvpur University)
THE NATIONAL COUNCIL OF EDUCATION, BENGAL
Jadavpur University Campus, Kolkata 700 032, West Bengal, India

APPLICATTON FORM
MBA (EVENING) COURSE
Session: 2020 - 2023
(All particulars to be filled in by the candidate in own handwriting)
Personal Information

First Name

Middle Name

Surname

Date of Birth

Please tick (√) wherever applicable

Female Male Married Single Indian NRI General OBC SC ST

Address

City

State

Pin

Tel. / Mobile No …………………………………………………..E-mail ………………………………………………………………………

Name of Father/Mother …………………………………………………………………………………………………………………………
Guardian’s occupation …………………………………………………………………………………………………………………………….
Whether you are presently occupied? Yes / No
Your work experience, if any:
Composite Score of the Entrance Exam (MAT/XAT/CAT/ATMA/JEMAT/CMAT) …………………………………………
Educational Qualification

Name of Examination Board/ Discipline Year Marks % of Marks

Council/ Obtained/ Total
University Marks
Secondary (Class 10
Level)

Higher Secondary (Class 12

Level)
Graduation (10+2+3 or 4
Level)
Post Graduation Degree

Professional/Additional Qualification (if any)

Programme Institute / University Duration Marks Obtained

Extra Curricular Activity (if any):

Activity Level of Participation (Inter –School or Remarks
College/State/National/International)

DECLARATION:
I declare that all the statements made in this application are true to the best of my knowledge. I am aware that
providing false information or suppressing relevant information may lead to rejection of my candidature. I also
undertake, if admitted, I will abide by the rules and regulations of the Institute and I shall not directly or indirectly
involve myself in any form of activities tantamounting to RAGGING and if detected, shall remain open for my
punishment.

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

Date Signature of Parent /Guardian Signature of the Applicant

Answer these questions (Compulsory). Write within 15 to 20 words

(a)What are your strengths?

(b) How do you come to know about this institute?

(c) Why are you interested to pursue the course in the Institute of Business Management?

(d) What are your expectations from this institute?