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Registration Form

 

Exam Undertaken
Score: Composite/Percentile
 

APPLICANTS PERSONAL DETAILS:

Name*
Date of Birth
 
Gender
Nationality
 
Category
Telephone : (M)*
 
(Residency.)
Email*
 
Father's Name
Occupation :*
 
Telephone : (M)*
 
(Res.)
Email*
 
Mother's Name
Occupation :*
 
Telephone : (M)*
 
(Res.)
Email*
 

ADDRESS FOR COMMUNICATION:

Adress:
 
City:
 
State
 
Pincode:
 

PERMANENT ADDRESS:

Address:
 
City:
 
State
 
Pincode:
 

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
 
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

 
10th Note: Image format jpeg or gif or pdf file. Max size 100kbs
 
12th Note: 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)

 

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: