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PADMASHREE DR. D.Y.

PATIL UNIVERSITY
NAVI MUMBAI
(Established under section 3 of the UGC Act, 1956 (NAAC Accredited A) Dnyanpushpa Niketan, Plot No. 10, Sector-4, CBD Belapur, Navi Mumbai 400 614. Tel.: 91 22 2756 5618 | Fax : 91 22 2757 5064 | www.dypdbm.com

(Ranked A++ by Business India, Nov. 2011 | Ranked amongst Top 100 B-Schools In India by Dalal Street Journal, Nov. 2011 | Most promising B-School, Brands Academy, April 2011 | Ranked 57th in India, The Week 2010)

APPLICATION FORM FOR THE MASTERS IN BUSINESS ADMINISTRATION (MBA) 2 Years Full Time Program - Core & Sectoral Programs (please number them in order of preference.
Thus: 1 = 1st preference) Preference given to the programs
1. MBA in Core Program 2. MBA in Retail Management 3. MBA in Outsourcing Management 4. MBA in Health & Hospital Management 5. MBA in International Business Management 1. Name in Block Letters: 2. Fathers Name: 3. Mothers Name: 4. Date of Birth: 5. Place of Birth:

APPLICATION NO.:
6. MBA in Biotechnology Management 7. MBA in Bioinformatics Management 8. MBA in Pharmaceutical Industry Management 9. MBA in Banking & Insurance Management 10. MBA in Logistics and Supply Chain Management Surname:

6. Gender: Male/Female 8. Religion: 10. Address for communication:

7. Nationality: Indian______________(Mention name of the country) 9. Sub Category: SC/ST/DT/NT1/NT2/NT3/SBC/OBC/VJ/OTHER/GEN

Tel. No.+STD Code & : Mobile No: Email :

11. Permanent Address:

Tel. No.+STD Code & : Mobile No: Email :

12. Educational Qualification: Degree Arts / Sci / Com / Engg. etc. SSC HSC Degree Post Graduation Year of Passing Name of the University %age marks obtained

13. Name of the entrance examination undertaken:

CAT

DYPCET

MHCET

CMAT

14. Year of taking the above exam: 15. Score obtained at the above entrance exam: 16. Work Experience (if any):

Name and Address of the Employer

Position

Period of Give in Brief the Job responsibilities Employment

Last Salary drawn (Rs. per Month)

17. Whether represented in sports at state/National level (Please Attach Certificates) 18. Explain briefly your career and educational objective in applying to the MBA Program.

Yes

No

19. Declaration: I hereby declare that whatever is stated above is true to the best of my knowledge and belief.

Date: Place : Signature of the applicant

ATTESTED COPY OF THE FOLLOWING DOCUMENTS:


1) 2) 3) 4) 5) HSC Mark Sheet & Certificate FY/SY/Graduation Result with passing Certificate Transfer Certificate / Leaving Migration Certificate Passport / Electricity Bill / Ration Card 6) 7) 8) 9) 10) Valid Passport & Visa (for foreign national) Birth Certificate Work Experience Certificate Caste Certificate Entrance Score Card (CAT or MHCET or CMAT)

FOR OFFICE PURPOSES


Marks obtained in the All India Qualifying Exam :___________________________________________________________________ Or Marks obtained at the DYPCET Entrance Exam :________________________________________________________________ Marks obtained at GD :_______________________________________________________________________________________ Marks obtained at PI :________________________________________________________________________________________ Additional Marks for Work Experience :__________________________________________________________________________ Additional Marks for Sports Activity :_____________________________________________________________________________ Total Marks :_______________________________________________________________________________________________ Admitted : Yes / No

Co-ordinator of Admission

Registrar

Director

PADMASHREE DR. D.Y.PATIL UNIVERSITY


NAVI MUMBAI
(Established under section 3 of the UGC Act, 1956 (NAAC Accredited A) Dnyanpushpa Niketan, Plot No. 10, Sector-4, CBD Belapur, Navi Mumbai 400 614. Tel.: 91 22 2756 5618 | Fax : 91 22 2757 5064 | www.dypdbm.com

(Ranked A++ by Business India, Nov. 2011 | Ranked amongst Top 100 B-Schools In India by Dalal Street Journal, Nov. 2011 | Most promising B-School, Brands Academy, April 2011 | Ranked 57th in India, The Week 2010)

G.D. / P.I. HALL TICKET (Full Time MBA) YEAR-2012 Name of the Candidate : Hall Ticket No. Place of Exam : : Padmashree Dr.D.Y.Patil University Department of Business Management, Dnyanpushpa Niketan, Sector-4, Plot No.10, CBD Belapur, Navi Mumbai 400614 :

APPLICATION NO.:

Students Photograph

Date

Supervisors Signature

Applicants Signature

PADMASHREE DR. D.Y.PATIL UNIVERSITY


NAVI MUMBAI
(Established under section 3 of the UGC Act, 1956 (NAAC Accredited A) Dnyanpushpa Niketan, Plot No. 10, Sector-4, CBD Belapur, Navi Mumbai 400 614. Tel.: 91 22 2756 5618 | Fax : 91 22 2757 5064 | www.dypdbm.com

(Ranked A++ by Business India, Nov. 2011 | Ranked amongst Top 100 B-Schools In India by Dalal Street Journal, Nov. 2011 | Most promising B-School, Brands Academy, April 2011 | Ranked 57th in India, The Week 2010)

G.D. / P.I. HALL TICKET (Full Time MBA) YEAR-2012 Name of the Candidate : Hall Ticket No. Place of Exam : : Padmashree Dr.D.Y.Patil University Department of Business Management, Dnyanpushpa Niketan, Sector-4, Plot No.10, CBD Belapur, Navi Mumbai 400614 :

APPLICATION NO.:

Students Photograph

Date

Supervisors Signature

Applicants Signature