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Kerala Institute of Co-Operative Management: Application For Mba Fulltime Programme (2020-2022)

This document is an application form for the MBA full-time program at the Kerala Institute of Co-operative Management (KICMA) for the years 2020-2022. The form requests personal details such as name, date of birth, contact information, academic qualifications, entrance exam scores, work experience, and category under which the applicant wants their application considered. The declaration at the end states that all information provided is true. The checklist provides instructions on documents that must be submitted along with the application such as photos, mark lists, certificates, caste certificates if applicable, self-addressed stamped envelope, and fees payment details.

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Vinu Vavi
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112 views3 pages

Kerala Institute of Co-Operative Management: Application For Mba Fulltime Programme (2020-2022)

This document is an application form for the MBA full-time program at the Kerala Institute of Co-operative Management (KICMA) for the years 2020-2022. The form requests personal details such as name, date of birth, contact information, academic qualifications, entrance exam scores, work experience, and category under which the applicant wants their application considered. The declaration at the end states that all information provided is true. The checklist provides instructions on documents that must be submitted along with the application such as photos, mark lists, certificates, caste certificates if applicable, self-addressed stamped envelope, and fees payment details.

Uploaded by

Vinu Vavi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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KERALA INSTITUTE OF CO-OPERATIVE MANAGEMENT ​(KICMA)

Approved by AICTE and affiliated to University of Kerala Promoted by State Co-operative


Union, Kerala, Govt. of Kerala Nettukal Hills, Neyyardam P.O. , Thiruvananthapuram-695 572,
Kerala Phone : 8547618290, 0471-2272601, 2272602, 2272603 e-mail : ​[email protected]
Website : www.kicmakerala.in ​APPLICATION FOR MBA FULLTIME PROGRAMME
(2020-2022)
(FILL THE FORM CAREFULLY IN CAPITAL LETTERS)
SERIAL NO. REGISTER NO.
1.

DETAILS OF FEE AMOUNT : ​REMITTED DD/RECEIPT NO :

AFFIX RECENT ​BANK : PASSPORT


​ ​ ​Name in full
SIZE ​DATE : ​PHOTO 1.

............................................................
2. Age 3. Date o f birth 4. Sex 5. Nationality
6. Community with religion .............................................
7. State whether you belongs to (​Put a ✓ mark in the appropriate column ​)
8. Aadhar number
9. Communication Details
Permanent Address
E-mail :
Address for correspondence
E-mail : Pin Pin Mob Mob
10. Father’s Name............................................................
11. Mother’s Name .........................................................
12. Local Guardian’s Name .............................................
13. MANAGEMENT APTITUDE TEST DETAILS
(​Attach True Copy of Score Card​)
SC ST OEC OBC GENERAL
Mob
Mob
Mob
Name of the Test
Roll No. Form No. Test Month &
Date
Composite / Total Score
Rank
C MAT K MAT CAT
14. ​Academic information ​(​Attach True Copy of all certificates​)
Course
Month &
Name of Year of
Examination Completion
passed and Board / University
Pass / Fail
NA ​ NA
% ​10​th ​or Equivalent ​ Plus II or Equivalent ​
Graduation or
Equivalent
Name of College
...........................
...........................
...........................
Parts of Examination
Semester 1
Semester 2
Semester 3
Semester 4
Semester 5
Semester 6
Semester 7
Semester 8
Total ​Post Graduation or Equivalent Name of College ...........................
NA
15. Additional Academic qualification (​if any​) :
16. Details of work experience (​if any​)
Organization Designation Period
17. Under which category you want to consider your application
Merit Quota Relatives of Co-operative Employees / Director Board Members etc.
SC /ST Reservation Others
(Specify)....................................................................................
(In case you prefer for co-operators/ dependent of co-operative employees quota , p​lease furnish the certificate from
the Co- operative Institution concerned) 1
​ 8. Extra curricular activities (if any) :
.......................................................................................................
19. Do you want to avail hostel facility in the campus ​Yes No
Marks Secured
Max. Marks
DECLARATION
I hereby solemnly and sincerely affirm that the statements made and the information
furnished in this application form submitted by me are true. I understand that any
misrepresentation by me in this application will disqualify my candidature at any point of
time.
Place: Date: Signature of the Applicant Signature of Parent
Check List
What should you send with the application?
• ​Photo pasted on the top the application.
• ​Copies of mark lists, Degree / Provisional certificate and K-MAT/CMAT /CAT Score Card
• ​Copies of Caste Certificate in case you belong to SC/ST Community.
• ​Self addressed stamped envelope.
• ​Fees Remittance details.
2. ​
3. ​FOR OFFICE USE ​Application Received on :
Received by :
Mode : By Post
By Hand By Spot Admission Faculty Consulted ( ​Name with Signature and date​) :
1.

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