APPLICATION NUMBER

Use only BLACK or BLUE Hi-Tec point type pen to fill up the form
Fill the form in English using CAPITAL letters, except for signature
Do not fold, staple or clip the form

MBA - MEDIA & ENTERTAINMENT

NAME OF THE APPLICANT

DATE OF BIRTH
SEX (TICK ONE)

DATE MONTH YEAR MALE FEMALE

NAME OF PARENT/GUARDIAN

ADDRESS FOR CORRESPONDENCE (DO NOT REPEAT NAME)

CITY PIN CODE

STATE

STD CODE TELEPHONE NUMBER MOBILE NUMBER

EMAIL ADDRESS

PHOTOGRAPH LEFT THUMB

IMPRESSION OF APPLICANT
Paste your recent passport
size color photograph
not older than 3 months
Do not pin or staple

SIGNATURE OF APPLICANT

Sign within the box without touching the edges PLEASE TURN OVERLEAF
EDUCATIONAL QUALIFICATIONS

DETAILS OF 10 + 2

SL NO INSTITUTION SUBJECTS MARKS OBTAINED PERCENTAGE YEAR OF PASSING

DETAILS OF GRADUATION

SL NO INSTITUTION SUBJECTS MARKS OBTAINED PERCENTAGE YEAR OF PASSING

ENTRANCE TEST PAYMENT DETAILS

ISSUING BRANCH ISSUING BRANCH

PAYMENT OPTION NUMBER DATE AMOUNT NAME CODE

SBI CHALLAN

DEMAND DRAFT

DECLARATION: I he reby de cl are tha t all the particular s in this application form are true to the best of my
knowledge and belie f. I have rea d and unde rstood all the pr ovisions of admissions and agr ee to abid by the m. I also
affirm that I fulfill the e ligibility r equir eme nts of the course/s a pplie d. In eve nt of submission of fra udulent,
incorr ect or suppression or distortion of any fact like education qua lifica tion, m arks, nationality e tc…., I unde rsta nd
that my a dm ission/de gre e is liable for cancell ation. I furthe r unde rsta nd that my a dm ission is pure ly provisional
subject to ve rifica tion of the el igibility conditions

Note: T he fill ed a pplication form along w ith ma ndatory docume nts has to be subm itted along w ith an applica tion
fee of INR 1000/- (INR One T housand only), by Cash or by crossed De mand D raft draw n in favour of Ma nipal
Universa l Lea rning Priv ate Li mite d pa yable a t Banga lore. The a pplication ne eds to se nt to the following a ddre ss

Manipa l Educa tion

No. 14, HAL Airport Road
2nd Floor, M anipa l Tow ers
Bangalore – 560 008
Tel: + 91 80 40789225

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SIGNATURE OF PARENT/GUARDIAN SIGNATURE OF APPLICANT