ADMISSION FORM - OCTOBER 2016 vate: TO) Please tick the program you are applying for: Energy 1 Transportation 7 MBA [Oil & Gas] DBA (Aviation Operations} 1 MBA [Power] MBA (Aviation| Infrastructure MBA [Logist & Supply Chain) Personal Det: TMPORTANT GUIDELINES: All the below mentioned fields are mandatory Please mention N/A wherever nat applicable 1. Name [in Block Letters): 2. Date of Birth: (X [] (0) [OI Gender M[] F[] Others[_] 3. Correspondence Address: Pin: 000 Telephone No: ()[J( CIC ICICI oO Mobile: DOO0OO0O0O 4, Permanent Address: Pim TO OOOO Tetephone No: (JO OOOOO000 mobile: OOOOOO000 5. Email: 6, Nationality 7. Occupation 8, Name of the Company: 9. Designation: 10. Employer's Address: 11. Telephone (off): ] JO OOOOOO0Class X Class XII Graduation Post Graduation Any Other Name of the Organization Website Newspaper O Emailer 1 SMS © Magazine C1 AnyOther Declaration Ufereby slate hath area an sores te othe es ol my owe cas ry norton s ond o be act ny cana sal tobe ancl by the Univers. shal aide by the regulations othe Unversty of Petrlaum ana Energy Sates, including ess code, and cxpected fetavoral norms ine wih the Universe saci hata sa cnsre ey parent tal oppcel dae. Student's SignatureINFORMATION FORM FOR IDENTITY CARD IMPORTANT GUIDELINES: All the below mentioned fields are mandatory Please fillin BLOCK LETTERS. 1. Name of the Program: Energy Transportation 1 MBA Oil & Gas} 1D BBA (Aviation Operations} 1 MBA [Powerl MBA (Aviation) 11 Infrastructure MBA Logistics & Supply Chain) 2. Duration of the Program: MBA: October 1st 2016 to September 30th 2018 BBA: October 1st 2016 to September 30th 2019 3, SAP ID [For Office use only): (_]{_J(]{ JCJLILIL 4, Student's Name [in English Capital Letters} 5. Father's Name: 6, Mother's Name: 7. Correspondence Address: Pin JOO Tetephone Nor) JOO OO0OU000 wobite: ] JD OOOODOO00 8, Permanent Address: rin: JOOOO0 Tetephone No: JO OOO0000 wobite: J OO OOOOO00 9. Telephone (ort): J CD OOOOOO000 10. Emergency Contact No: I IO OOONOO000 11. Blood Group: |] L) J Authorized Signatory Specimen Signature of the StudentINSTRUCTIONS FOR SENDING THE ADMISSION FORM Please send the filled in Admission Form along with: 1. Non-refundable Admission Form fees of €1,000/- {through demand draft} in favor of “UES”, payable at Dehradun, 2. Xth & Xlith class certificates and mark sheets (photocopies should be self attested]. 3, Graduation certificate & mark sheets [photocopies should be sell attested). 4. Any other degree/diptoma/certificate {as mentioned in the application form). 5. 2 passport size photographs affixed on the form. 6. 1 passport size digital photograph and scanned signature. 7. Work experience certificate(s} 8. Completed ID form. All the above documents along with filled in Application Form should be sent to the following address: Centre for Continuing Education University of Petroleum and Energy Studies 2nd Floor, 210, Okhla Phase -3 Industrial Area, New Dethi -110020 Tel : +91-11-41730151-53 Email : enrollments.cce@upes.ac.in www.cce.upes.ac.in