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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