Diploma in Agribusiness Management (DABM

Application Form
Personal Details: First Name Middle Name Last Name Date of Birth

:___________________________________ :________________________________ :___________________________________ :___________ :___________

Affix your recent passport size photo here

Gender (Male/Female)

Address for communication :

__________________________________________________________ __________________________________________________________ __________________________________________________________


Pincode:_________________ State:___________________________

Contact Number: STD code: _______Tel.No.:______________________ Alternate Contact Number: STD code: _______Tel.No.:______________________ Mobile Number: ________________________________ Personal E-mail:________________________________ Official E-mail:_________________________________ Educational Qualification: Degree : _________________ Post-Graduation : ___________________ How do you know about the course: Newspaper Occupation: (please tick the right option) Student Self Employed Designation Service Others Experience in years Website Seminar Others

(If self-emplo yed/service/others please provide the details)

Name of the Organisation Program Details: (please tick the right option) Mode of Learning: Classroom (Weekend

Distance Learning Weekdays ) Bangalore at par Cheque Pune Delhi

(If classroom mode, then specify the location & batch time)

Location and Timing: Mumbai Mode of Payment: Cash

Payment Details: (please tick the right option) Demand Draft (DD)
(DD/Cheque to be in favor of ‘Welingkar Institute of Management Development & Research’ payable at Mumbai/Bangalore)

DD/Cheque number


Drawee Bank/Branch

DD/Cheque Date

I hereby certify that the above information provided by me is true and correct. I have read & understood the terms & conditions & agree to abide by the same.

Date Place

: ____________________ : ____________________

____________________ (Candidate’s Signature)

The duly filled & signed application form should be sent to us at ‘Welingkar Institute of Management, L.N. Road, Matunga (C.R.), Mumbai – 400 019. Tel. 91-22-24178300 ext. 450. e-mail : commodities@welingkar.org

For Office Use Only------------------------------------------------

Admission No. :______________ Receipt No./Challan No. :______________
© Welingkar Institute of Management

Authorised Signatory Date

:______________ :______________

MCX is India’s No. 1 commodity exchange. Source: FMC website (www.fmc.gov.in) based on turnover in terms of value for FY 07. Disclaimer: Multi Commodity Exchange of India Limited proposes, subject to receipt of requisite approvals, market conditions and other considerations, to make an initial public offer of its equity shares and has filed a draft red herring prospectus (“DRHP”) with the Securities and Exchange Board of India (“SEBI”). The DRHP is available on SEBI website at www.sebi.gov.in as well as on the websites of the book running lead managers at www.dspml.com, www.citibank.co.in , www.jmfinancial.in, www.kotak.com and www.enam.com. Investors should note that investment in equity shares involves a high degree of risk and for details relating to the same, see the section titled “Risk Factors” of the aforementioned offer document

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