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Niis Institute of Business Administration: Application Form
Niis Institute of Business Administration: Application Form
ADMINISTRATION
Sarada Vihar, Madanpur, Bhubaneswar, Orissa, Pin 752054
Ph: -(0674)2113232, Fax: (0674)2113242, E-mail:niba_bbsr@yahoo.com, Webwww.niisinst.com
Application Form
1. APPLICATIION FOR ADMISSION INTO:
_____________________________________________________
2. RANK IN MAT/CAT/XAT/ATMA/JEE/CET (IF ANY):
___________________________________________
3. NAME OF THE CANDIDATE (IN BLOCK LETTER):
______________________________________________
4. (A) FATHERS NAME
:__________________________________________________________________
(B) MOTHERS
NAME:__________________________________________________________________
(C) GUARDIANS NAME (If father is not
alive):______________________________________________
(D) RELATIONSHIP OF GUARDIAN WITH
APPLICANT:_________________________________________
(E) OCCUPATION OF FATHER/GUARDIAN:
_________________________________________________
(STATE EXACT DESIGNATION OF SERVICE WITH DETAILS)
:____________________________________________
PH NO.
(RES):_____________________________(OFF)______________________________________
5. DATE OF BIRTH (DD/MM/YYYY):
________________________________________________________
6. NATIONALITY: ___________________________ (A) STATE TO WHICH STATE:
____________________
7. SEX :___________________________________ (A) BLOOD
GROUP:____________________________
8. IF SC/ST/OBC/GENERAL, SPECIFY:
_______________________________________________________
9. PRESENT ADDRESS:
___________________________________________________________________
_________________________________________________________
_________
PIN:____________________________PHONE (WITH STD
CODE):______________________________
10. PERMANENT ADDRESS:
______________________________________________________________
_________________________________________________________
_________
PIN:____________________________PHONE (WITH STD
CODE):______________________________
11. NAME & ADDRESS OF LOCAL GUARDIAN OF BHUBANESWAR WITH TEL
NO. IF ANY _____________
__________________________________________________________________________________
_
12. ACADEMIC QUALIFICATION:
EXAM
UNIVERSITY/BOARD/C
PASSED
OUNCIL
YEAR OF
PASSING
DIVISIO
N
%OF
MARKS
DECLARATION
Date:
Place:
Signature of the Candidate
DECLARATION BY PARENT/GUARDIAN
I have gone through the prospectus of the Institute and hereby declare that
the application is made with my consent. I take the entire responsibility for
the good conduct of my ward, payment of full fees in time without default
and will not allow my ward to discontinue while in middle of the course.
Date:
Place:
Signature of the Parent/Guardian