MBA_PGDM APPLICATION 12553611 Preference 1: MBACU Preference 2: MBAKE Preference 3 : MBAAN Name: NIVEDITA UPADHYAY Gender: Female e-mail:

nive14sweet@gmail.com Category: Other Indian States Date of Birth: Place of Birth: Nationality: Religion: Section: 14/01/1991 mathura Indian Hinduism General Educational Qualification: Qualification: Board/Uni Institution: State: % Y/M of Pass Attmp Dr.bhim Rao 1 BBA Ambedkar Gla Uttar Pradesh 67.13 2012, June University ,agra Amarnath Vidya 1 Class 11/12 Cbse Uttar Pradesh 77.8 2009, May Ashr Amarnath Vidya 1 Class 10 CBSE Uttar Pradesh 74.0 2007, May Ashr Pre-requisite Exam: Month: Year: Roll No: MAT Composite: 683.5 Feb 2012 902210743 Work Experience In No of Years:0.0 Parent Details: Relationship: Name: Occupation: Income: Father dr.yogesh upadhyay Doctor 100000 - 200000 Mother mrs.mridula upadhyay Home Maker < 100000 Current 89 jagannath puri , , mathura, Uttar Pradesh, India, 281001 Address Permanent 89 jagannath puri , , mathura, Uttar Pradesh, India, 281001 Address Phone Number: 91 0565 9760781445 Mobile Number: 91 9675517479
Declaration

I, NIVEDITA UPADHYAY , hereby undertake to uphold the motto of Christ University and strive to excel in my studies with all ability. I hereby declare that if I do not have at least 85% attendance in each subjects at the end of each Trimester/Semester/Year. And if I do not keep up the ideals of the University and my conduct is not good and indulge in any behavior or act that may come under the definition of ragging, the Vice Chancellor/the Registrar/Office of Admission/Controller of Examinations/Department has right not to permit me for any University Exam/detain me or terminate my admission at any time during my study.

I Further promise to abide by the rules and regulations of this Institution

Date: Signature:

Parents Signature:

Candidates

Dear NIVEDITA UPADHYAY , thank you for your interest in Christ University. Your application 12553611 has now been submitted for review and once we receive all the supporting documents we will follow up with an email shortly.In the meantime, please feel free to visit www.christuniversity.in for answers to any questions you may have about the program or the admission/application process. Confirmation mail has been sent to nive14sweet@gmail.com READ ALL INSTRUCTIONS CAREFULLY Kindly take a print out and send this application form, after pasting a recent passport size photograph wearing Formal Dress and of Photo size of 35mm x 45 mm with White background - Standard Indian Passport Format (This Photograph will appear in the Final Degree Certificate), in the space provided for photograph. Send the following supporting documents in an A4 size envelope only

I. One Copy of the SBI Application Fee paid Challan. II. 4 recent passport size photographs wearing Formal Dress and of Photo size of 35mm x 45 mm with White background - Standard Indian Passport Format.This Photograph will appear in the Final Degree Certificate. (Write your name and application number behind the photographs) III. The original filled-in printed application form duly signed by the parent/guardian and the candidate IV. Copy of Statement of marks of Class 10, Class 12 and Degree (Available) V. Copy of Transfer Certificate from last qualified Institution, Provisional and Degree Certificates (available)

VI. Copy of Entrance Test Score Card 2011 (Sep MAT 11/Dec MAT 11/Feb MAT 12/CAT 11) VII. Copy of Migration Certificate for candidates from outside of Karnataka (If available) VIII. Copy of Passport and Visa Page (If available) if from Outside India To: PO Box No 2920, Hosur Road, Bangalore . 560029 Or Candidates sending the above documents by Courier Service should address the same to; The Office of Admissions, Christ University, Hosur Road, Bangalore - 560 029 Or Candidates may submit the forms directly at ; Office of Admissions, Room No.108, First Floor, Central Block, Christ University Main Campus, Bangalore - 29 Candidates must mark the application as MBA Admissions 2012 - 12553611 on the top left hand corner of the A4 size envelope to facilitate faster processing. The above supporting documents should reach us within 7 days of submitting the application online on or before March 27, 2012 by 4 PM. You can check your application status on the URL :appstat.christuniversity.in
Checklist for the Applicant Tick the relevant box before you send the application form
1. I have filled-in the correct information 2. I am attaching Copy of SBI application fee challan

Yes No

3. I have written my name, application number, on the back of 4 photos which is enclosed 4. I have pasted a photo on the space provided in application form 5. I am attaching the copy of MAT/CAT Score Card (Sep MAT 11/Dec MAT 11/Feb MAT 12/CAT 11) 6. I am attaching the copy of statement of marks card of Class X & Class XII 7. I am attaching the copy of my available Degree Marks Cards (Specify number) 8. I am attaching the copy of my Transfer (TC)/Migration Certificate 9. My Parent/Guardian and I have signed the declaration on the printed application form. 10. I have read the statement of undertaking and instructions regarding the Admission and Application process

Date: Place: Candidates Signature