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Dr.D.Y.

PATIL INSTITUTE OF MANAGEMENT &


RESEARCH, Pimpri-411018.
(Forwarded Through Training and Placement Department)

1.

GENERAL

1.1 Name: _______________________


____________________________
Surname
Fathers Name

___________________________
First Name

1.2 Date of Birth :


1.3

Day
Present Address :

Month

Year

___________________________________________________________________________
_________________________________________________PIN
1.4 Address for contacting:
_______________________________________________________________________
_________________________________________________PIN
1.5 Phone (R) ______________________ ________

Mobile

No.____________________________
1.6 E-Mail Address : ______________________________________
2.

EDUCATIONAL QUALIFICATIONS:

Examinat
ion
Post
Graduati
on
Graduati
on
H.S.S.C.
or
Equivale
nt
S.S.C. or
Equivale
nt

Board /
Institution

Year of
Passin
g

Marks
Obtaine Out of
d
(Total)

No. of
Attempt
(s)

2.2 Title of Project in MBA :


_________________________________________________________________________
Organisation :
____________________________________________________________________________
Brief description about the Project:
___________________________________________________________________________________
___________
___________________________________________________________________________________
____________
___________________________________________________________________________________
____________
___________________________________________________________________________________
___________
____________________________________________________________________________________
___________
2.3 Additional Qualifications, if any :
_________________________________________________________________________________
___________
_________________________________________________________________________________
___________
__________________________________________________________________________________
___________
3. EXTRA CURRICULAR ACTIVITIES
Sr.
No.

4.

Name of Activity

Level of Participation :
College/University/Dist
rict / State/ National

Year of
Participation

ADDITIONAL INFORMATION, IF ANY


__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Date : -----------------------Signature ------------------------

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