Shri Shankaracharya Group of Institutions

PO. Nehru Nagar, Junwani, Bhilai 490 020 Dist. Durg (C.G.)
Phone No. 0788-2291605, 2291607, 2291609 Fax: 0788-2291606
Website: www.ssm.ac.in, www.ssimt.ac.in , www.ssecb.ac.in , www.ssitm.ac.in,

REGISTRATION FORM (MBA-2011)

BIO DATA OF CANDIDATE
Name of the Student (in block letters)
Affix
Your recent
passport
Date of Birth Age Category size
photograph

Father’s Name Mother’s Name

Father /Guardian’s Profession Designation

Local Address with Tel. No.

*Permanent Address with Tel. No. (Compulsory)

*e-mail address (Compulsory) Annual Income

Rs.

Educational Qualifications
Sl. Month / Year Board /
Exam Passed %age
No. Of Passing University
1 12th
Graduation
3 P.G
4 MAT SCORE

• If you have appeared in any of the following exams, please mark ( √) :

CAT ATMA XAT

Any Other Information ______________________________________________________________________

Details of DD: No.:__________________ Dated : ____________ Name of Bank :____________________

Signature

INSTRUCTIONS
1) Candidates who have appeared in MAT (Sep 2010, Dec 2010, Feb 2011 and May
2011) or in CAT / ATMA / XAT (2010-2011) for the admission in MBA program
of the below-mentioned institutes of Shri Shankaracharya Group of Institutions are
required to fill this form.
• Shri Shankaracharya Mahavidyalaya, Junwani, Bhilai.
• Shri Shankaracharya Engineering College, Junwani, Bhilai.
• Shri Shankaracharya Institute of Technology & Management, Junwani,
Bhilai.

This form ensures their registration to GD and PI session of the selection procedure
of these institutes.

2) A DD of Rs. 500/- in favor of “Director, SSGI” must be attached with this form.

3) The registered students will be communicated through phone / email about the
dates of GD and PI.