APPLICATION. 1. Full Name of the Candidate: Mr. / Ms. (In block letters beginning with surname) 2. Address for Correspondence: Pin: Mobile:
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1 ill j THE MATRIX EDUCATIONAL FOUNDATION'S MATRIX SCHOOL OF MANAGEMENT STUDIES (Approved by AICTE & Affiliated to University of Pune) Survey No. 9/1/5, 9/2/4 & 9/1/4, Off Westernly Bypass Road, Next to Sinhgad Science College, Vadgaon, Ambegaon (Bk.), Pune Tel.: Fax : APPLICATION Form of application for Admission to: Full Time Courses under University of Pune. 1. Master in Business Administration Programme. MBA (2 yrs) (Please see information for filling up this form on the back page of the form.) 1. Full Name of the Candidate: Mr. / Ms. (In block letters beginning with surname) In Devnagari Script: 2. Address for Correspondence: Ph.(with STD Code): 3. Permanent Address: Mobile: Pin: Ph.(with STD Code): Mobile: Pin: 4. Date of Birth (in figures): DD MM YY Date of Birth (in words): 5. Birth District: 6. (a) Name of Father or Guardian: Village: State: Taluka: Nationality: (b) Relationship of Guardian with the Candidate: 7. Present Address & Telephone No. of the : Father or Guardian 8. Permanent Address & Telephone No. of the : Father or Guardian 9. Father's / Guardians annual income from all sources (Rs. per year): -1 -
2 10. Is your father a State / Central Government Employee? YES / NO In case of Yes give the date when he was posted in Maharashtra : 11. Do You belong to: (i) Scheduled Castes or Scheduled Caste converted Neo. Buddhas? (ii) Scheduled Tribes including those outside specified areas (iii) Denotified Tribes and Nomadic tribes? i iv) Other Backward Classes? (v) Other than (i) to (v) above: (State the Caste supported by a copy of Certificate) 12. Do you belong to the/economically Backward Class? 13. Whether you are a holder of Government of India Backward Class Scholarship during the last year? Yes / No 14. State whether you have applied for admission to MBA Programme to any other Institute, If so give the name of the Institute. (1) (2). 15. Extra Curricular Activities: (i) Participation in Debating /Any other: (ii) University / State level: (iii) Participation in Cultural activities (drama / music etc.): (iv) Medals / Trophies obtained for distinguished performance: (v) Any other: (Enclose attested copies in support of your claims as above.) APPLICATION FORM - TO BE FILLED BY THE OFFICE 1. Application for: 2. Received on. DD MM 3. Seat No. of Qualifying Entrance Test: 4. Total Score in the Test (GET): Written GD PI WE PAR Total 5. Signature of the Officer (who verified the certificates attached with remarks if any) -2- Name Signature
3 CERTIFICATES (To be attached) ] Attested copies should be attached in the following order Please state clearly whether attached or not (Attestation has to be from Director, MSMS and for that Original Certificate will be necessary) Sr. No Details Birth Date (S. S. C. Certificate) Certificate of Physical Fitness from Registered Medical Practitioner SSC Certificate / Statement of Marks HSC Certificates / Statement of marks and other certificates please specify, (a) Graduation Certificate : (b) Graduation Mark List : (c) Representation in sports / games / competition Representation in cultural activities Documentation for Reserve Category candidates a) Specify Category (i.e. whether) SC / ST / DTNT / OBC / NT 1 / NT2 / NT 3 b) Creamy layer certificate c) Caste Validity certificate Transfer Certificate from the last College attended. Migration Certificate from last University attended. (Other than Pune University) Gap Certificate Father's / Mother's Domicile Employer's Certificate Qualifying Examination Income certificate Any other (PI. Specify) TOTAL NUMBER OF CERTIFICATES ATTACHED (SAY YES/NO) I hereby declare that the information given above is true to the best of my knowledge and belief and that the certificates which are not furnished by me are not relevant to my application. NOTE : The candidates whose results are yet to be declared should produce statement of marks immediately on declaration of his / her results latest by 30th September. Unless this is done the student will not be eligible under the University Rules. As such his admission will be cancelled. Therefore please ensure to submit statement of marks before the last date specified. Signature of the Candidate -3-
4 16. (a) Give Details of Schools, Colleges Attended Starting From S. S. C. Examination Onwards Sr. No. Name of the Examination passed Name of the Degree or Diploma awarded (eg. BA, BE Civil) Name of the School / College attended (with District & State) Name of the Examining Body /University Specialisation (Subject) Max. Marks Marks Obtained Percentage of Marks obtained Class Grade - Remarks (Please specify if any distinguished performance) S.S.C. (10th) H. S. C. (12th) Graduate Degree Post Graduate Degree Post Graduate Diploma Any other (b) Please Give The Details of The Certificate Courses or Short Term Diploma Courses If You Have Completed
5 DECLARATION TO BE SIGNED BY THE CANDIDATE I hereby declare that, I (I) I have read all the rules of Admission and I have consulted my parents / guardian and after understanding these rules, I have filled in application for admission to the M.B.A. Programme at Matrix School Of ManagementStudies, Ambegaon(Bk.) The information given by me in the application is true to the best of my knowledge and belief. I have not been debarred from appearing at any examination held by any Government Constituted or Statutory authority in India or abroad. (iv) I fully understand that admission once granted in particular category, will be final & I will not be entitled to have admission in any other category. Depending on my inter se merit and availability of a seat my admission is subject to verification of my original testimonials for obtaining the eligibility. (v) I understand that no other document, other than those attached to the application form will be entertained forthe purpose of claims/concessions/weightages etc. if any in connection with my admission. (vi) I hereby agree to abide by all Rules, Acts and Laws in force by Government / University / Institute / Society and hereby undertake that so long as I am a student of the Institute I will do nothing either inside or outside the Institute which may result in disciplinary action against me under the Rules, Acts and Laws. (vii) I fully understand that the Director of the Institute where I would be admitted, will have full liberty to expell me from the Institute for my infringement of the rules of conduct and discipline, attendance and the information given above (viii) I undertake to observe full attendance as per the University/Institute Rules and failing which I am aware that my terms will not be granted. Signature of the Candidate Name: Declaration To Be Signed By The Candidate Belonging To Backward Class I understand that admission given to me against quota forthe reserved category is provisional and will be cancelled if my caste claim is rejected by the Director Social Welfare Maharashtra State, Pune & if I have not submitted all required document in support of my claim. Signature of the Candidate Name: -5-
6 CERTIFICATE OF PHYSICAL FITNESS (by a Registered Medical Practitioner) I certify that I have carefully examined Mr./Ms and further certify that his/her eyesight is good and any minor defects therein can be over come by means of suitable glasses; that his / her Constitution is sound; and that he / she has no disease bodily or mental infirmity unfitting him / her now or likely to unfit him / her in future from work in the Institute or active outdoor service as an M.B.A, student. Date : _ Signature : Address : _ Name : Qualification Registration No.: NOTE: In case of the foreign students they should undergo tests for AIDS at the recognised medical Institute and produce the certificate from any Civil Surgeon or Dean Medical College to that effect. -6-
7 UNDERTAKING (To be given by Parent / Legal Guardian) In the event of Matrix School of Management Studies(MSMS) considering the application of Mr./Miss son / daughter of Mr. residing at I Mr/Mrs. of Mr./Ms. _for admission to MBAprogramme (Parent/Legal Guardian) hereby agree to pay adhoc fees / fees prescribed by the competent authority / College Authority. I hereby further agree and undertake that if the fees (Tuition + Development) and other charges/ fees decided by the Shikshan Shulka Samiti / Competent Authority are more than the adhoc fees for the current academic year, then I will pay the difference to the Institute on demand. I shall also pay the fees and other charges decided by Shikshan Shulka Samiti / Competent Authority for the subsequent Academicyears in time. agree Student Parent / Legal Guardian -7-
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