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Directorate of Technical Education, Maharashtra State, Mumbai

First Year MBA/MMS Admissions 2014 Application Form DIRECTORATE OF TECHNICAL EDUCATION
3 , MAHAPALIKA MARG, POST BOX NO. 19 67, MUMBA I - 4 00 0 01 APPLICATION F ORM F OR A DMISS ION TO FIRS T YEA R OF TWO- YE AR FULL-T IME POS T GRADUA TE COURSE S IN MA NA GE MENT VIZ. MBA/ MMS/ PGDBA /PGDBM FOR THE ACADEMIC YE AR 20 14 -1 5

APPLICATION ID : MB14160400
Pe rs on al De ta il s C a nd id ate 's Nam e ANKIT GUPTA Father 's Nam e NA RE SH KUMA R MA HAWAR Mother 's Nam e SHAS HI DEVI MAHAWA R G ende r Ma le D ate o f Birth 18 /1 2/ 19 91 C a nd id ature T yp e OMS Hom e Unive rs ity Othe r Th an Ho me Un iv er si ty C ateg or y No t Ap pl ica bl e - NA (0 ) P er so n with Dis ab ility No t Ap pl ica bl e App lied fo r EB C ? No Ap ply fo r A ll I ndia Se ats Ye s Qu al if ic ati on Deta il s Qu ali fi ca tio n 10th/S .S .C ./Equiv alent 12th/H.S .C ./Equiv alent Gr ad uatio n Gra duation S ta tus Pa ss ed G rad ua tion Fa culty En gi ne er ing / Te ch no lo gy Ma rk s Obtai ne d 3 76 .00 3 97 .00 59 45 .0 0

VERSION NO : 1

Mar ks OutOf 5 00 .00 5 00 .00 80 00 .0 0

Per ce nta ge 7 5.20 7 9.40 7 4.31

G ra duation T yp e Fu ll -T im e Gr ad ua tio n Pa ssing Y ea r 20 13

Gr ad uatio n Unive rs ity Ra ja stha n T ec hn ica l Un iv ers ity Al l In di a E xa m Detai ls

Sr. No. 1. 2. Exami nat ion Name C A T ( C o ndu c t ed by I I M s ) XA T (C ond uc te d by XL RI ) Roll No SR 9 2 7 9 7 1 7 2 08 591 R ank Total Score Percent ile 6 9 .6 6 4 7 .9 8

MA H- MBA/ MMS -CET 20 14 Date Pre fe re nce s Date Pr efe re nc e 1 16 /0 3/ 20 14 MA H- MBA/ MMS -CET 20 14 City Pre fe re nce s C ity Pr efe re nc e 1 Ne w De lh i (De lh i) C ity Pr efe re nc e 3 Mu mb ai Ap pl ic ation F ee De ta il s
Sr. No. 1. R ef erence No 10 07 721 2 A mount Pa id ( Rs.) 1 0 2 0 .2 2 / P ayme nt Date 1 4 /0 2 /2 0 1 4 P ayme nt Mode D e bi t C ar d

Date Pr efe re nc e 2 15 /0 3/ 20 14 C ity Pr efe re nc e 2 Ja ip ur (Raj as th an)

Li st o f Doc um en ts Re qu ir ed at the ti me o f Doc um en t Ver if ic ati on a t A RC

Sr. No. 1. 2. 3. 4. 5. 6. Document Na me C e rt ific ate o f I nd ia n N a tio na li ty in t he N a me o f the C an di dat e. St at em en t o f M a rks o r C e rti fi c a te of P as s in g of S td. 1 0 t h / S .S .C . / E qu iv ale nt E xa min at io n. St at em en t o f M a rks o r C e rti fi c a te of P as s in g of S td. 1 2 t h / H .S .C . / E qu iv ale nt E xa min at io n. St at em en t o f M a rks o r C e rti fi c a te of P as s in g of G rad ua ti on E x am in ati on . Sc or e C a rd of C A T (C on du c te d by I I M s ). Sc or e C a rd of X A T (C on du c te d by X L RI ).

Dec la ra tion
I hav e re ad all the r ule s o f a dmiss io n and o n unde rs ta nding thes e Rule s, I ha ve fille d this Ap plic ation For m fo r c onside ratio n of s ubm is sion of A pp licatio n Fo rm at A RC f or the ad miss ion to MB A/MMS/PGD BA /P GDB M fo r the ac ad em ic Y ea r 2014-2015. The infor ma tion g iv en b y me in this a pplic atio n and in P ro fo rma -I is tr ue to the be st of my knowled ge & b elief . I f a t later stage , it is f ound tha t I ha ve
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2/14/2014

Directorate of Technical Education, Maharashtra State, Mumbai

furnis he d wro ng inf or matio n and/or subm itte d false c er tific ate(s), I am a war e that m y ad mis sion s ta nds ca nc elle d and fe es paid b y me will b e fo rf eited . Furthe r I will be subje ct to leg al a nd /o r pe na l ac tion a s p er the pr ov isions of the la w. Plac e : D ate : 14/ 02 /2 01 4 Pr inte d On : 14 /02 /2 01 4 3:2 8:54 PM La st Mod ified O n : 1 4/ 02 /20 14 3 :2 8:3 4 PM La st Mod ified B y : MB1 41 604 00 , 11 7.2 26 .9 .47 S ig na ture of A pplic ant ( ANKIT GUPTA )

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