DPU Dr. D. ¥. Patil B-School ~ POST GRADUATE DIPLOMA IN MANAGEMENT (PGDM) (AICTE Approved) Application fo Academic Year 2017-2019 Specialization: [] Marketing [] Finance [arm [is [ir [operations & Supply Chain Management Appeared For (y/) CAT / MAT / XAT CMAT / ATMA in the (month & year) Past aste Your Score: —____ Percentile recent passport size Centre for GD (PE; Yphotograpts here | wish to apply fo the above course Candidate’ Sign “My personal details are as given below. ‘understand that if admitted, my admission will be provisional and will be confirmed only upon the submission of my Transfer Centfcate all other Certficates/Marks Statement from my previous college / Educational Institute / Eligibility Cerificate, as the case may be, and subject to fulfillment of eligibility criteria as stated inthe prospectus Personal Information Summame Fist Name Second Name Name in Full (a BLOCK leters) Permanent Address: Ph, No, Local Address: MobileNo: [0 E-mail 1D: Date of Binh (Das! Moh Yi Marital Status: Single [1] Mand [] Blood Group Place of Birth: (da BLOCK teters) Place, Taluk, Stat Father's / Husband’s Name Mobile Number Father: [0] Mother: [iEducational Details: Mention all Univesity & Board Examinations that you have passed beginning with Std. X/S.S.C, 1 of the College / Institute pot Year | % of Marks ‘Special / Optional Subjects Course Employment / Experience “Mention details beginning from present employment, Total Duration en ‘Achievements, ifany Name of the Organization Designation & Nature of Job Undertaking: .# Thereby submit to the disciplinary jurisdiction of the Director and other authorities ofthe Institute and shall observe and abide by the rules made by the Director / University .& have carefully read and noted the rules and process of admission as given in the prospectus that lam required to follow and shall in matters of interpretation aecept the decision given by the Director in this respect as final and binding, + [shall atend minimum 85% overall ofthe lectures and 80% of the lectures per subject, as per the rules, failing which I shall not approach the Director or Faculty for any concession in this regard, and shal be lable to be debarred from taking the ‘examination 1 Thave also read, understood and accept the code of conduct and the notification displayed on the General Notice Board of the Institute and I shall take note of all communications that wll be put up and follow the same from time to time # Thave noted and accepted that all orientation lectures / camps / seminars / meets / guest lectures / workshops training etc. are compulsory and it is obligatory on my part to attend the same from time to time. Signature of the Candidate