Mba Application

Application No : PG/
APPLICATION FOR ADMISSION TO

M.B.A PROGRAMME Karpagam Academy of Higher Education
(Established Under Section 3 of UGC Act 1956)
Pollachi Main Road, Eachanari Post, Coimbatore - 641 021 INDIA Phone : 0422-2611146, 2611082 Fax: 0422-2611043
Email : [email protected] Web : www.karpagamuniversity.ac.in
1 Course Applying for :
2 Name (in block letters) (as in the HSC Mark Sheet)

Affix a Passport size
Photograph duly attested
by the candidate
3 Name of Parent / Guardian :
and Occupation
4 Sex : Male Female
5 Date of Birth & Age :
6 Nationality :
7 Community
(Enclose attested Photostat copy : OC BC MBC DNC SC ST
of the Community Certificate)
8 Address for Communication (Please note this is the address to which the University will send all correspondence)
PIN Code
E-mail Address Fax No
Telephone No (Mobile)
9 Permanent Address (if different from address above)
PIN Code
E-mail Address Fax No
Telephone No (Mobile)
www.karpagamuniversity.ac.in
APPLICATION FOR ADMISSION TO M.B.A PROGRAMME
10 Details of Qualifying Examination (U.G. Level) : Passed Yet to Pass
a. Degree & branch of study :
b. Name of the College :
c. Name of the University :
d. Month & Year of Passing :
Marks obtained upto Percentage

Subjects Maximum Marks
V sem / II year of Marks
Part I
Part II
Part III
(excluding FC, NSS etc.,)
Major / Main
Ancillary / Allied I
II
(Attested Photostat copies of the certificates shall be enclosed)
11 Details of other PG courses applied for in this University
12 Hostel facility required : Yes No
13 Extra curricular activities :
DETAILS OF SUBJECTS AND MARKS OBTAINED IN THE QUALIFYING EXAMAINATION UPTO V SEM. / II YEAR
Subjects No of Attempts Marks Secured Maximum Marks % of Marks

Part I
1
2
3
4
Class in Part I Total in Part I
Part II
1
2
3
4
Class in Part II Total in Part II
Part III : (Main, Elective & allied / ancillary subjects)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Total in Part III
Attested :
Signature and designation of the attesting officer with seal
I certify that all the above statements and entries are true
Station :
Date : Signature of the candidate
DECLARATION BY THE APPLICANT
I hereby declare that all the informations furnished by me in this application and the documents, submitted
in support of my application are true, complete and correct to the best of my knowledge and belief.
I declare that I will abide by the rules and regulations of the University enforced from time to time.
Signature of the Applicant
DECLARATION BY THE PARENT
I declare that my Son / Daughter / Ward will abide by the rules and regulations of the University enforced
from time to time.
Date : Signature of the Parent / Guardian
FOR OFFICE USE ONLY
Name of the Student Application No
Course admitted :
Enrollment No. : Admitted on
Fees collected vide receipt No. : Dt Rs.
Dayscholar / Hosteler
OFFICE IN-CHARGE REGISTRAR
Register No. PG/ 2010-11/
(To be Submitted in Duplicate)
Entrance Test for Admission to the

M.B.A Programme 2010- 2011
Karpagam Academy of Higher Education
HALL TICKET (Established Under Section 3 of UGC Act 1956)

Pollachi Main Road, Eachanari Post, Coimbatore - 641 021
Name of the Candidate
Course applied :
Affix a Passport size
Photograph duly attested
Date of Examination : by the candidate
Time of Examination :
Examination Centre :
Specimen Signature of the Candidate

The candidate is required to report at the test centre one hour before the commencement of the
test and present this Hall Ticket. The Candidate is permitted to write the entrance test, subject to the
condition that he/she satisfies the Eligibility conditions prescribed for admission to the course. REGISTRAR
INSTRUCTION TO THE CANDIDATES :
? Hall Ticket (in duplicate) should be duly filled in and passport size photograph to be affixed by the
candidate and submitted along with the application.
? Register Number, Examination Venue and Center Code are assigned by the office.
? Request for change of examination center will not be entertained under any circumstances.
? Candidates without the valid hall ticket will not be permitted to enter the examination hall.
? Issue of the hall ticket alone does not entitle the candidate for admission into any of the courses.
? Fill up the form in Capital Letters.
Address to which the Hall Ticket is to be sent (IN CAPITAL) :
To To
Name ____________________________________________________ Name ____________________________________________________
Address ____________________________________________________ Address ____________________________________________________

____________________________________________________ ____________________________________________________
____________________________________________________ ____________________________________________________
PIN
____________________________________________________ PIN
____________________________________________________

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Application No : PG/

APPLICATION FOR ADMISSION TO

1 Course Applying for :

2 Name (in block letters) (as in the HSC Mark Sheet)

4 Sex : Male Female

5 Date of Birth & Age :

E-mail Address Fax No

9 Permanent Address (if different from address above)

E-mail Address Fax No

10 Details of Qualifying Examination (U.G. Level) : Passed Yet to Pass

a. Degree & branch of study :

b. Name of the College :

c. Name of the University :

d. Month & Year of Passing :

Marks obtained upto Percentage

(Attested Photostat copies of the certificates shall be enclosed)

11 Details of other PG courses applied for in this University

12 Hostel facility required : Yes No

13 Extra curricular activities :

Subjects No of Attempts Marks Secured Maximum Marks % of Marks

DECLARATION BY THE APPLICANT

Signature of the Applicant

DECLARATION BY THE PARENT

Date : Signature of the Parent / Guardian

FOR OFFICE USE ONLY

Name of the Student Application No

Enrollment No. : Admitted on

Fees collected vide receipt No. : Dt Rs.

(To be Submitted in Duplicate)

Entrance Test for Admission to the

HALL TICKET (Established Under Section 3 of UGC Act 1956)

Name of the Candidate

Specimen Signature of the Candidate

INSTRUCTION TO THE CANDIDATES :

Address to which the Hall Ticket is to be sent (IN CAPITAL) :

Address ____________________________________________________ Address ____________________________________________________

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