SVKM’s Narsee Monjee Institute of Management Studies (NMIMS)

(Declared as Deemed-to-be University under Section 3 of the UGC Act, 1956 vide Notification
No.F.9-37/2001-U-3 dated 13th January, 2003 of the Government of India)
____________________________________________________________________________
JVPD Scheme,Vile Parle (W), Mumbai – 400 056.India – Tel.: 26134577/26183688
Fax :91-22-26114512 E-mail : [email protected] :http//www.nmims.edu

Roll No.
Application No. : Year of Admission -

NMAT Roll No.

(8 Digit) Rank G. R. No.

ADMISSION FORM
(To be filled in by candidate’s own handwriting) Affix Recent
Passport size
colour
Photograph

Mukesh Patel School of Technology Management & Engineering

Master of Computer Application (M.C.A.)

A.1. NAME : Mr./Ms. _______________________________________________________________

(In full Block letters) Surname Name Father’s/Husband’s Name

(B2 to B8 Mark 9 or X )
D D M M Y Y
B.1. AGE : Yrs. Months DATE OF BIRTH

(As on 31/05/2010)

B.2. SEX : Male Female Blood Group +ve/-ve

B.3. MARITAL STATUS : Married Unmarried

B.4. CATEGORY : Open SC ST OBC Other ____________

B.5. COMMUNITY : Gujarati Gujarati Speaking Others _____________

B.6. NATIONALITY : Indian Others (If Other, Specify) ________________

B.7. DOMICILE : Maharashtra Others (Specify the state) _____________

Region : Whether Belong to East West North South

B.8. University : Mumbai Other (If Other, Specify) ____________________

C.1. Work Experience :

Name & Address of From To Total Designation Remuneration

Organization Years/ Per Annum
(Start with recent Months
one)

(Attached separate sheet if required)

D.1. ACADEMIC PERFORMANCE (Stages of Education)

Examination Degree Awarded Univers Month & Marks Perce Class

(Part Time/Full ity/ Year of ntage /Grad
Time/Distance/ Board Passing e
Correspondence Obtai Out
) ned of
Master’s Degree
(Enter marks only
if final result is
declared)

Other Degree/
Diploma Cert. (only
if Passed)H.S.C.
Bachelor’s Degree
Course (Please
Specify)
1st Yr. I Sem
II Sem
2nd Yr. III Sem
IV Sem
3rd Yr. V Sem
VI Sem
4th Yr. VII Sem
VIII Sem
H.S.C

S.S.C.

D.2. NAME OF THE COLLEGE/INSTITUTE LAST ATTENED __________________________

E.1. APPLICANT’S ADDRESS : ______________________________________________________

________________________________________________________________________________

________________________________________________________________________________

E.2. PHONE : Residence : ______________________ Mobile : _______________________

E.3. E-Mail Address : _______________________________________________________________

F. FAMILY BACKGROUND
F.1. FATHER’S/GUARDIAN’S NAME : _______________________________________________

F.2. OCCUPATION : ________________________________________________________________

F.3. OFFICE ADDRESS : ___________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Email Address :_______________________________________________________________

Tel : __________________________________ Mobile : ______________________________

F.4. MOTHER’S NAME : ____________________________________________________________

F.5. ANNUAL FAMILY INCOME : ___________________________________________________

F.6. PERMANENT ADDRESS : ______________________________________________________

________________________________________________________________________________

_______________________________________________________________________________

Tel : ___________________________________ Mobile : ____________________________

F.7. LOCAL GUARDIAN’S NAME : _______________________________________________________

ADDRESS : _________________________________________________________________________

_____________________________________________________________________________________

______________________________________________________________________________________

Email Address : ______________________________________________________________________

Tel : __________________________________ Mobile : _____________________________________

 (Kindly intimate in writing immediately to Admission office, if there is any change in
address or telephone no.)

G. Declaration by the Candidate & Parent :

G.1. In case Final Year Degree Marksheet & Migration is not submitted by 30/10/2010, my
admission will stand cancelled automatically.
G.2. I fully understand that no other document than those required will be entertained
on priority for admission.
G.3. I fully understand that the admission to the course will be made depending on my inter-
se-merit and availability of a seat at the time of scrutiny of my application and when I am
called for the offer of a seat.
G.4. I fully understand the rules for cancellation of admission & that fees once paid will be
refunded as per the rules applicable at that time.
G.5. I hereby undertake that I shall pursue the studies at NMIMS and shall not do anything
inside or outside the NMIMS, which may result in disciplinary action against me.
G.6. I hereby agree to observe rules relating to library, Computer Lab, I-Card & Code of
conduct of NMIMS which are in force and amended time to time.
G.7. I fully understand that the Vice Chancellor/Registrar, of the NMIMS or the competent
authority will have full liberty to expel me from the institute for any infringement of the
rules of conduct and discipline and the undertaking given above. So also if I am caught
using any unfair means during examination.
G.8. I fully understand that the Vice Chancellor/Registrar, of the NMIMS or the competent
authority will have full liberty to expel and/or debar me from the Institute if I am proved
guilty of using unfair means during examination.
G.9. I fully understand that in case of grade and/or grade points, it is the candidate’s
responsibility to convert the grade and or grade point into the marks & submit it at the
time of admission.
G.10. I fully understand that I must put in 80% of the attendance for each subject in the
absence of which I will not be eligible to write the exams for the subject.
G.11. The information furnished by me in this application is true to the best of my
knowledge and belief.
G.12. I am aware that ragging is banned in the University and if I found indulging in ragging is
liable to be punished appropriately which may include expulsion from the Institute.
G.13. I hereby solemnly declare that I have read all the Rules of admission and I have
consulted my parents/guardian and after fully understanding the Rules I have
filled in this application.

I have checked all the entries in this application. They are true, I have kept all
enclosures ready to be present on demand if admitted. I agree to comply with the rules
of the Institute.

All the disputes are subject to Mumbai Jurisdiction.

I agree & will abide rules &

conditions of the Institute

Place : ________________ ________________________

Signature of the Student
Date : _________________
I affirm that my son /daughter will abide
rules & conditions of the Institute

_______________________________
Signature of Parent/Guardian

(Note : The candidate should submit the attested Xerox copies of the testimonials as per
the checklist on A4 size paper only. Further you are advised to retain one set of Xerox
copies for your future reference.)
 FOR OFFICE USE ONLY

Remarks : Checklist for verification of Certificates : Yes No

Part Fees Paid : Rs. _________ 1. S.S.C. Passing Certificate

Date: ____________
2. HSC Marksheet
Balance paid Rs : ___________
Date: ____________ 3. Degree Marksheet (for 1,2,3,4th year)

Full Fees Paid Rs: _________ 4. Degree Certificate

Date : ____________
5. Provisional Degree certificate

6. Post Graduate Degree Marksheet

Admission Granted/
Not Granted 7. Post Graduate Degree Certificate

8. AIU (University Equivalence) Certificate

9. Leaving Certificate from School

last attended

Registrar/Vice Chancellor 10. Migration Certificate

11. Work Experience Certificate

12. E or D level exam Score Card

conducted by C-DAC

13. Medical Fitness Certificate (In Original

signed by Registered Medical Practitioner)

Remark :

Checked by Verified by Dy. Registrar

______________________________________________________________________________________

Fees received vide Receipt No. ________________ dated _______________ for Rs. ___________

By cash/cheque/D.D. No. ____________________ dated _______________ drawn on ________

_______________________ Received by _________________________________

Challan No. (Dena Bank) : ________________ Fees Amt : _______________ Date : __________

Challan No. (Dena Bank ) : _______________ Hostel Fees Amt : _________ Date : __________