Department of Management Studies (Doms), Indian Institute of Technology Madras

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Application No.

DOMS3867

Category General

Centre C/M

Experience 0 Months

CAT 2011 Regn. No. SR7519396

CAT Percentile

56.69

Department of Management Studies (DoMS), Indian Institute of Technology Madras


Application for admission to

MASTER OF BUSINESS ADMINISTRATION (MBA)


Full-Time (2012-2014) 1. Name 2. Address Affix recent passport size photograph duly attested : polimera s kesava reddy polimera : mallayapallem street,prathipad d.no:2-78,pushpalatha fruits shop s/o POLIMERA SIVA REDDY City : guntur (dt) Pincode 3. Tel. No : Landline : 91888573335 Mobile 4. E-mail : sivareddy.polimera@gmail.com 5. Gender : Male 6. Category : General & None 7. DOB : 24-08-1990

: 522019 : 91888573335

8. Academic Record Qualification and % of marks /CGPA (Semester Wise, if applicable) X Std XII Std UG Degree : B.Tech UG Branch : CS Graduation Year :2011 Overall % : 70.65 Class : First Class with Distinction
JNTU KAKINADA

School & Board / College & University 87.00% 92.90%

PRAGATHI TALENT SCHOOL,BOARD OF SECONDARY ED UCATION SRICHAITANYA JR.COLLEGE,BOARD OF INTERMEDIAT E QIS COLLEGE OF ENGINEERING AND TECHNOLOGY

Semester

I Year 70.54

II Year III Year IV Year 75.33 66.40 62.36 65.06 68.80 79.85 PG Branch : Overall % :

PG Degree : Graduation Year : Class : I Year


Semester

II Year

9. Work experience (from latest to earliest) No Work Experience

10. Payment Details Amount Dated : Rs. 500 : 24-01-2012 DD No Bank : 234740 : INDIAN BANK,KALYAN NAGAR

11. GT/PI City Preferences : Chennai, Mumbai I Certify that all information provided by me in this form is correct to the best of my knowledge. I understand that willful supression/misrepresentation of facts will result in my dismissal from the programme.

Date :

Signature of the applicant

Mailing address for Applications: Admissions Co-ordinator MBA Programme, Department of Management Studies, Indian Institute of Technology Madras, Chennai. PIN - 600036. Tamil Nadu. Ph: 044 - 22575551 Email: msoffice@iitm.ac.in

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