Post on 13-Dec-2015
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Dr B R AMBEDKAR NATIONAL INSTITUTE OF TECHNOLOGY
JALNDHAR -144011
APPLICATION FORM FOR ADMISSION TO MBA PROGRAMME 2013-2014
S No ___________
Application Fee: Rs 500/-(Gen/OBC) For SC/ST/PH – Rs. 250/-
To be filled in by the candidate in his/her own handwriting in capital letters
Please attach attested copies of all the document/certificates/testimonials.
1. Details of Registration fee:
Demand Draft No____________ __Dated ___________ __Amount ____________ Bank/Branch ___________
2. Name in full (in block letter as per matriculation certificate)
in English __________________________________________________
3. Father’s Name ______________________________________________________
4. Mother’s Name ______________________________________________________
5. Date of Birth (as per matriculation certificate) ______________________________________________________
6. Nationality ______________________________________________________
7. Category (Please tick the relevant box)
a) General OBC SC ST
b) PH Yes No
8. Educational Qualification
Examination Year of
Passing
Institution University Subject(s) Marks
Obtained/Max
Marks
%age marks
(up to one
decimal)
10+
10+2
B.Sc/B.E/B.TECH/
BA/BBA
Any other
examination
Self attested
Passport Size
PHOTOGRAPH
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9. Correspondence Address with telephone no ______________________________________________________
______________________________________________________
______________________________________________________
STD code________ No __________________________________
Mobile no _____________________________________________
Email id ______________________________________________
10. Permanent Address with telephone no
______________________________________________________
______________________________________________________
______________________________________________________
11. a) CMAT DETAILS
ROLL NO DATE OF EXAM RANK
b) CMAT Score (BEST OF All SCORES ADMISSIBLE FOR ADMISSION IN 2013-2014)
QT&DI LR LC GA TOTAL
SCORE
(OUT OF
400)
TOTAL
SCORE
(OUT OF
80)
Marks
obtained
Total
Marks
Marks
obtained
Total
Marks
Marks
obtained
Total
Marks
Marks
obtained
Total
Marks
100 100 100 100
OR
c) NITJ Entrance Score Overall Max Marks ________ __________ Overall Marks Obtained ________________
12. Was there any gap in your studies? If yes, mention period and reason
a) Period (give dates) From __________________________________ To________________________________________
b) Reasons __________________________________________________________________________________________
13. List of enclosures
I. Application fee (Demand Draft) yes/no
II. Matric/higher secondary certificate (as proof of age) yes/no
III. Plus 2 Examination certificate yes/no
IV. B.SC/B.Tech/B.A/BBA/B.E* yes/no
V. Examination Certificates indicating detailed marks yes/no
VI. Character certificate from head of Institution last attended yes/no
VII. Certificate in support of claim under reserved category on prescribed Performa yes/no
VIII. Original CMAT score card copy yes/no
IX. Original Migration Certificate** yes/no
X. Medical certificate from the Medical Officer of the Institute at the time of Admission/Registration yes/no
Undertaking by the Applicant
I clearly understand that the my admission to MBA programme in the Department of Humanities and Management is SUBJECT
TO RULES AND REGULATION OF Dr. B.R. Ambedkar National Institute of Technology, Jalandhar. I also understand that the
admission is being allowed to me on the basis of information furnished by me. In case any information any particular is found
false/ wrong at any stage, NIT Jalandhar can cancel my admission and all the fees deposited by me shall be forfeited. In such case
I shall have no claim, whatsoever, in respect to my admission.
Full signature of parent/Guardian (Full Signature of Candidate)
Dated
Place
*Degree passed through Distance Education must be approved by the respective statutory body
**Student may submit within one month after admission
Note
Total score (out of 80) = Overall Marks obtained X 80
Overall Maximum Marks