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Directorate of Technical Education, Maharashtra State, Mumbai

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DIRECTORATE OF TECHNICAL EDUCATION


3, MAHAPALIKA MARG, POST BOX NO. 1967, MUMBAI - 400 001

APPLICATION FORM FOR ADMISSION TO FIRST YEAR OF TWO-YEAR FULL-TIME POST GRADUATE COURSES IN MANAGEMENT VIZ. MBA/MMS/PGDBA/PGDBM FOR THE ACADEMIC YEAR 2012-13 APPLICATION ID : MB12159501 VERSION NO : 4 SEATNO:28030003
Personal Details : Full Name AGRAWAL LAKHAN PURUSHOTTAM Candidature Type Maharashtra - Type A Date Of Birth August 5, 1991 Region Urban Annual Family 50,000 - 1,00,000 Income Applied for EBC ? No PH Type NA Home University Mumbai University Pay-in-Slip No / Receipt No 417504 Amount( ) 1150/Axis Bank Branch Vashi Qualification Details : Qualification 10th / S.S.C. / Equivalent 12th / H.S.C. / Equivalent Graduation Faculty Graduation University District of Passing H.S.C. Appeared For All India Exam Date Febuary 1, 2012 Category Open Gender Male Religion Hindu Mother Tounge Hindi

Marks Obtained 553 515 Commerce Mumbai University Buldhana

Marks OutOf 650 600

Percentage 85.08 85.83

PAR 2 2

Graduation Status Appearing Graduation Type Full-Time District of Passing Thane Graduation Exam Name - CAT-2011, Prometric Testing ID - SR7490170, CAT E-Mail ID - LAKHANAGRAWAL05@GMAIL.COM, CAT Percentile - 62.93, CAT Marks 164

I am attaching the attested true copies of following required documents as per the sequence given herewith. [Candidate is required to show original documents for verification at ARC]
Sr. No. 1. 2. 3. 4. 5. 6. 7. Pay-in-Slip of Application Processing Fee. Proforma - I on Plain Paper (The Candidate who is not able to submit Indian Nationality Certificate is required to submit Proforma - I on Rs. 100/-Non-Judicial Stamp Paper). Certificate of Indian Nationality in the Name of the Candidate. Domicile Certificate clearly indicating the place of permanent residence issued by SDO / Dy. Collector of District. Statement of Marks or Certificate of Passing of Std. 10th / S.S.C. / Equivalent Examination. Statement of Marks or Certificate of Passing of Std. 12th / H.S.C. / Equivalent Examination. Score Card of CAT - 2011. Document Name

Declaration
I have read all the rules of admission and on understanding these Rules, I have filled this Application Form for consideration of submission of Application Form at ARC for the admission to MBA/MMS for the academic Year 2012-2013. The information given by me in this application and in Proforma-I is true to the best of my knowledge & belief. If at later stage, it is found that I have furnished wrong information and/or submitted false certificate(s), I am aware that my admission stands cancelled and fees paid by me will be forfeited. Further I will be subject to legal and/or penal action as per the provisions of the law. Place : Date:

http://www.dte.org.in/mba/CandidateModule/frmPrintApplicationForm.aspx

4/19/2012

Directorate of Technical Education, Maharashtra State, Mumbai

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Application Last Modified On : April 19, 2012 11:19:15 AM

Signature of Applicant (AGRAWAL LAKHAN PURUSHOTTAM)

http://www.dte.org.in/mba/CandidateModule/frmPrintApplicationForm.aspx

4/19/2012