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K.J. SIMSR - FormA Batch 2012-2014 Online Application Form

K.J. SOMAIYA INSTITUTE OF MANAGEMENT STUDIES & RESEARCH

VIDYANAGAR, VIDYAVIHAR(E), MUMBAI - 400 077 http://simsr.somai a.edu , Email-pgdmadmission@simsr.somai a.edu

APPLICATION FORM FOR 2012-2014 BATCH

FormA
POST GRADUATE DIPLOMA IN MANAGEMENT - (PGDM) POST GRADUATE DIPLOMA IN MANAGEMENT(INTERNATIONAL BUSINESS) - PGDM(IB) PERSONAL DETAILS Somai a Online Form 104602 No Name of the Candidate MATTU AKSHAY Registration No SR7523774 Entrance E am CAT Gender MALE Date of Birth 27-09-1991 (as per SSC(Xth) Certificate) Somai a GD PI Center NEW DELHI Address Correspondence E-127 GREATER KAILASH PART-1 NEW DELHI - 110048 DELHI 011- 29231591 Mobile - 09944134938 ASHOK KUMAR MATTU GENERAL MANAGER, RBI

Signature Blood Group

___________
O+ Permanent

E-127 GREATER KAILASH PART-1 NEW DELHI- 110048 DELHI 011 - 29231591 Email - aksha .mattu7@gmail.com

Telephone

Father's Name Occupation

Mother's Name Occupation

SUMAN MATTU BANKER, CANARA BANK

Academic Performance Qualifications

SSC (X) HSC (XII) / Diploma Graduation DegreeB.E/B.TECH Post Graduate / Master

B.E/B.TECH - INCOMPLETE Percentage Discipline Score Total of Marks 456 500 91.2 440 789 500 1000 88 78.9

Year of Passing 2006 2008 05-2012

Board / Universit C.B.S.E. C.B.S.E. VIT UNIVERSITY

Work E perience Total Months of Work E perience after Graduation as on 31st December 2011 : 0 Months Public/ Organisation Name Gt./ Pe iod (F om-To) PSU Current Job Previous Job(S) 1 Previous Job(S) 2 Previous Job(S) 3 Previous
simsr.somaiya.edu/simsr/adm/pgdm12/onlineform/Display.asp?mform=1

Salar

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K.J. SIMSR - FormA Batch 2012-2014 Online Application Form

J b(S) 4 Pa ment Details Pa men Mode CREDIT CARD

DDNo / Receip No. 202916108506

Bank / B anch Name AXIS BANK-MC

Da e 29-01-2012

Amo n 1650+500=2150

DECLARATION The info ma ion gi en b me i co ec . I hall p o ide ppo ing doc men a e idence he e e applicable. I nde and ha m admi ion hall be p o i ional and i ill be confi med onl if fo nd eligible af e he deg ee e amina ion e l a e decla ed. In he e en of an fal e info ma ion, I f ll nde and ha m admi ion o he co e ill be mma il cancelled. I hall abide b he le of he In i e a decla ed f om ime o ime. I al o nde and f ll ha an di p e ha a i e conce ning m admi ion, i bj ec o he j i dic ion of onl he High Co of M mbai.

Place : __________________ __________________

Da e :

Candida e' Signa e _______________________

simsr.somaiya.edu/simsr/adm/pgdm12/onlineform/Display.asp?mform=1

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