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Registration Form

2-Year Full Time Post Graduate Diploma in Management (PGDM)
[Approved by AICTE, Ministry of HRD, Government of India]

Form no.
Exam Undertaken :
Score: Composite/Percentile :
 

APPLICANT’S PERSONAL DETAILS:

(All details are mandatory. Please Fill in Capital Letters.)

Name * : Date of Birth :  
 
Sex : Nationality : Category :
Telephone * : (M) (Res.) Email * :
Father’s Name : Occupation :  
 
Telephone : (M) (Res.) Email :
Mother’s Name : Occupation :  
 
Telephone : (M) (Res.) Email :
 

ADDRESS FOR COMMUNICATION:

City: State: Pin code
 

PERMANENT ADDRESS:

City: State: Pin code
 

ACADEMICS:

Qualification Name of the Institution University/Board Main Subjects Year Cumulative % of Marks
Class X
Class XII
Graduation
Post Graduation
Any Other
 

EXTRA CURRICULAR ACTIVITIES:

S .No. Nature of Activities School Level University Level National Level
1.
2.
 

EMPLOYMENT DETAILS:

Period Organization Designation Salary Email/Phone of HR at the Organization
 

HOW DID YOU COME TO KNOW ABOUT BULMIM?

Word of mouth Alumni Mat Bulletin
Call from BULMIM Internet (Webs address: )
News papers (Name: ) Coaching Center (Name: )
 

DECLARATION

I hereby certify that the information provided in the Registration Form is complete, accurate and true to the best of my knowledge and belief. I have carefully read the contents of the prospectus together with enclosures/inserts and agree to all the terms and conditions mentioned therein. If admitted, I agree to abide by the rules and regulations of BULMIM as may be enforced from time to time. In case any of the information found to be incorrect, false or misrepresented, I may be expelled or/and my candidature may be cancelled from the institute at my cost and expenses.

Place : Name :
Date :
 

ENCLOSURES:

  1. Copy of Score Card of CAT/MAT/XAT/CMAT/ATMA Note: Image format jpeg or gif or pdf file. Max size 250kb.
  2. Copies of marks sheet & certificates of

    10thNote: Image format jpeg or gif or pdf file. Max size 100kb.
    12thNote: Image format jpeg or gif or pdf file. Max size 100kb.
    Graduation Note: Image format jpeg or gif or pdf file. Max size 100kb.
  3. Recent passport size photos Note: Image format jpeg or gif or pdf file. Max size 100kb.
  4. Sponsorship (if any) of the employer Note: Image format jpeg or gif or pdf file. Max size 250kb.
  5. A payment of Rs.1100 by either of the following ways: (out of a, b or c)
    1. CASH
    2. DD/Pay order in favor of BULMIM payable at New Delhi
    3. Online transfer (NEFT/RTGS) to UCO Bank, K. G. Marg, New Delhi,
      (IFSD Code: UCBA 0002036 and Account No. 2036011000 1509)

    In case of NEFT/RTGS transfer, provide the following details:

    Name of the Account Holder:
    Account Number:
    Bank Name:
    Transaction Date:
    Transaction-id:
 

FOR OFFICIAL PURPOSE:

RECEIPT NO.:
Received By:
Checked By:
Remarks:
 
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