NO

Guruvayurappan Coimbatore-Palakkad Road, Navakkarai Post,

Institute of Coimbatore - 641 105
Tel : (0422-2656292), (0422) 2656213
Management Fax: (0422) 2656633
A B-School offering MBA Programme, e-mail: gim@vsnl.com, gimmba@dataone.in
Approved by AICTE and affiliated to Bharathiar University Website : www.gimat.org
and accredited by National Board of Accreditation

Application Form for admission to the 2 -Year full time Affix a passport
MBA 2011-2013 (16th Batch) size
Photograph

Applicant’s full name :

(IN BLOCK LETTERS)

Date of birth : Age

Nationality :

a) Religion : Caste :
b) Whether belongs to SC/ST/OBC/MBC :
(if yes, attach certificate)
c) Whether physically handicapped Yes No

Permanent address : _________________________________________________

_________________________________________________

_____________________________ Pin code:____________

E-mail : _________________________________________________

Address for communication :

Pin code :

Father’s /Guardian’s Name :

Father’s /Guardian’s Occupation :

Father’s /Guardian’s official Address :

Pin code :

Telephone (with STD code) : Off. : Res. :

E-mail :
 Educational Qualification
Course Institution University Aggregate Grade/Class Period Year of
marks & of passing
Percentage Study
10th

PDC/H.Sc.

UG

PG

Photocopies of SSLC and qualifying mark statements are to be enclosed.

Score obtained in :

Name of the Test CAT MAT TANCET CET

Score

Spl. Remarks, if any

Additional qualifications, if any

Working Experience, if any

DECLARATION

I certify that the details furnished in this application are true to the best of my knowledge and belief. I will
abide by the rules of the institution, if admitted.

I am attaching DD No. ………………………………… Dated ……………………………………….. For Rs. …………………………….

Drawn on …………………………………………………….. Bank …………………………………………..Branch ……………………………..

Date Signature

FOR OFFICE USE ONLY

Score obtained in Entrance test ……………………………….. Score obtained in GD …………………………………

Score obtained in interview …………………………………………… Total Score …………………………………………………..
All original certificates have been verified and the candidate is admitted to the 2009-2011 batch of MBA.

Admission Co-ordinator
Admitted : Yes No.

Director