APPLICATION FORM

Affix Your
Recent Passport
Size Photo

PART 1 - COURSES APPLIED FOR IN THE ORDER OF PREFERENCE

1
2
3

PART 2 - PERSONAL DETAILS

1. Name in
Capital
Letters
2. Date of Birth : Age: Gender : Male Female
Day Month Year Years

3. Father’s / Mother’s / Spouse name

4. Address

ADDRESS FOR COMMUNICATION PERMANENT ADDRESS

Phone:

E-Mail:

5. Local Guardian’s Contact Address

Telephone

Mobile

Please indicate your relationship with the local guardians:

PART 3 - PREVIOUS EDUCATION DETAILS
6. SECONDARY EDUCATION
Secondary School attended and place

7. PRE-UNIVERSITY EDUCATION (10 + 2) / QUALIFYING

EXAMINATION Name of the School / College attended and place

8. MEDIUM OF INSTRUCTION IN PRE UNIVERSITY EDUCATION (10+2) / QUALIFYING EXAMINATION

9. MARKS SECURED IN QUALIFYING EXAMINATIONS

Marks
Subjects Maximum Marks Percentage ( % )
Obtained

Total:

PART 4 - DOCUMENTS REQUIRED

10th Marks Card Migration Certificate Nationality Certificate (International Students)

10 + 2 Marks Card Date of Birth Transfer Certificate

Certificate

Caste Certificate Income Certificate

PART 5 - STUDENT DECLARATION

a) I agree to abide by the rules and regulations of the Padmashree Group of Institutions (PGI).
b) I acknowledge that if I am selected for a course of study, I am liable to pay the fees for the full term and it will not be refunded under
any circumstances.
c) I am aware that 80% attendance is mandatory in all the subjects to be eligible to appear for the university examinations.
d) I am aware that usage of two-wheeler is not allowed in the college campus.
e) I am aware that consumption of alcohol and smoking is prohibited in the college and I agree to abide by this condition failing which
necessary disciplinary action will be taken against me.
f) I hereby agree that I will not cause any damage to the college property; I accept that failure on my part to abide by this policy may lead
to necessary disciplinary action and any related costs incurred by my actions will be recovered from me.
g) I am aware that delay in payment of the fees attracts a late fine.
h) I agree that it is an essential term of my agreement with PGI that information I have supplied in this form and any attached documents is true
and complete, and I acknowledge that PGI may suspend my enrolment if false information has been given or required information is not
given by the due date.

Student’s Signature Parent’s/Guardian’s Signature

Padmashree Institute of Management and Sciences, # 149, Padmashree Campus, Sulikerei Post, Kommaghatta, Kengeri,
Bangalore – 60 Telephone: 080-28485204/05 Principal: 9902863900 pimsprincipal@gmail.com www.pims.org.in