Sr. No.

SHREE CHANAKYA EDUCATION SOCIETY’S

INDIRA GLOBAL BUSINESS SCHOOL

PARANDWADI, TAL- MAWAL, DIST- PUNE- 410 506.
APPROVED BY AICTE, NEW DELHI AND AFFILIATED TO SAVITRIBAI PHULE PUNE UNIVERSITY

M.B.A - SECOND YEAR ENROLLMENT FORM

A.Y. 2020-21
_____________________________________________________________________________________________________
_
www.indiragbs.edu.in Email- admin@indiragbs.edu.in

PRN : 2051911188 Aadhaar No.: 407462393155

Specialization : MARKETING Bank A/C No.: 158542017798

Admitted in FY Through : MANAGEMENT PAN No. : ADAPF6214G
Candidature :. M.S. O.M.S. Voter ID No.: NILL

1. Full Name : __MD __________FAIZAL___________________________________________________________________________________________ (In

Capital) (Surname/ आडनाव) (First Name/ऩाव) (Middle Name/ वडडलाााांचे\पतीचे नाव)

2. Permanent : _332/6 CHAKIA

ALLAHABAD__________________________________________________________________________________
Address ________________________________________________________________________________________________________
(कायमचा पता) ________________________________________________________________________________________________________

3. Correspondence : _YOUR SPACE

WAKAD_______________________________________________________________________________________________________ Address
________________________________________________________________________________________________________
• (सााांपकाचा पता)
___________________________________________________________________________________________________________________________________Pe
rsonal Email __faizal0098@gmail.com_________________________________________

• Phone No.(दरध़वनीू ) : _______________________________________ Mobile (माााा॓बाईल नााां) :

_8542017798_________________________________________ (With STD Code)

4. Date of Birth : __04_____/___11______/_____1995____________ Nationality

:___INDIAN_______________________________________________
(जऩमददनाााांक) (DD/MM/YYYY)
5. Category :
 OPEN OBC SC ST DT/NT VJ
SBC

6. Full Name of Father: __MOHD RIZWAN___________________________________________________ Mob No. (माााा॓बाईल नााां):

__9450632797__________________________

7. Full Name of Mother: _NAGMA RIZWAN____________________________________________________ Mob No. (माााा॓बाईल नााां)

___9795801583_________________________

8. Full Name of Local: ___MANAS PRADHAN__________________________________________________ Mob No. ( माााा॓बाईल नााां)

__8087112026__________________________ Guardian (If any)

DECLARATION TO BE SIGNED BY THE CANDIDATE

As per guidelines, I, __MD FAIZAL________________________________________ completely aware about the rules and regulations
laid down by the institute. I understand, to confirm in Second Year MBA, I should clear the fee which is subject to
change as per guidelines of Fees Regulating Authority, Govt. of Maharashtra.
I hereby give my consent to pay the difference if any, in the fees as & when to be announced by Fees Regulating
Authority.

Date:__18/07/2020______________________________

Place: _ PUNE_____________________________
_______________________________________________
(Signature of the Candidate)

• Payment Details:

Bank Name: INDUSIND BANK

Account Number: 158542017798

Name of Account Holder: MOHD FAIZAL

Transaction ID: Ref no. 20015682268

Date: 18/07/2020