Name / Logo of

Counseling Associates

Application form for Two Years Post Graduate Diploma in Management-Hybrid Program
(Distance Learning Mode)

Batch : Counseling /Enrollment Center :

Personal Details

Surname Chouhan

First Name Aamir

Husband/Father's Name Khadim

Date of Birth 3 0 0 4 1 9 9 8

( D D/M M/Y Y Y Y)

Gender MALE FEMALE

Affix 1
passp
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Preferred address for correspondence HOME OFFICE
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photo
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Home Address Office Address

Flat no – 10, Legend CHS LTD

Plot no – 46, Near Asmita Supermarket

Naya nagar
_
City : Mira Road City :
Pincode : 401-107 Pincode :
State : Maharastra State :
Country : India Country :

Resi. Tele : Office Tele :

Mobile No. : Mobile No. :
Email Id : Email Id :_
Aadhaar No.:
Educational Background (Mention only your main or highest qualification as of date)
(College or University should be recognized by UGC / AICTE /State Govt. otherwise admission will be cancelled at any time.)
Examination Board / University Conducting the Exam School / College Attended Year of Passing
B.M.S Mumbai University Shankar Narayan Collage 2019
(CBCGS)

Please mention if appeared for exam and result awaited.

 Work Experience
Total Work Experience Years
Name of Present Organisation Type of Industry Designation Nature of Work

Any Course done from the Welingkar Institute of Management

Course Name Year of Passing Roll No.

Preferred Specialization
Marketing ( ) E-Business ( ) Rural & Agri Business ( )
Finance ( ) International Business ( ) Healthcare Management ( )
Banking, Investment & Insurance Gen. Mgmt. ( ) Media & Advertising ( )
( )
Human Resource ( ) Retail ( ) Hospitality Management ( )
Operations ( ) Services Excellence ( ) E-Commerce ( )
Supply Chain ( ) Travel & Tourism ( ) IT Projects Management ( )
Fee Plan Selection:
Two years PGDM –HB (HPGD) Lateral Admission for Two years PGDM –HB (LPGD)
Fee Plan Amount Fee Plan Amount
2 years fees (without PCP) paid in advance 81,000/- Lateral Entry fees paid in advance 66,000/-
2 years fees (with PCP) paid in advance 84,600/- Lateral Entry Fees(37.5+30.5) 68,000/-
Yearly Fees (without PCP) 43,500/- Dual Admission for Two years PGDM –HB (MPGD)
Yearly Fees (with PCP) 47,100/- Fee Plan Amount

Yearly Fees (23.6 +13+13) (with PCP) 49,600/-

Dual specialisation fees 42,500/-
Yearly Fees (20 + 13 +13) (without PCP) 46,000/-
Payment Details
Payment Mode
Sr. Bank Name /
Date (Chq/Credit Card Amount Payment details
No. Branch Name
/Online /POS

PDC should be within 90 days

Exam Centers (to be selected only from the list of Centers mentioned on the welingkaronline.org website)

Exam Center Name :

Student Undertaking
1) I undertake to keep sufficient balance in my bank account to honour the PDCs, given by me, on due dates.
2) In case, the cheque is dishonoured for any reason, | will pay the due amount along with the applicable cheque bouncing charges through
demand draft within 7 days of intimation of dishonour of cheque.
3) In case, I fail to pay the dues within 7 days, the Institute shall have the right to deactivate my online access till I make the payment.
4) In case, I am unable to pay my dues within 15 days, my admission will stand cancelled and the fees earlier paid by me will be forfeited and
I will not be eligible for any refund of fees earlier paid, if any
5) It would be assumed that students seeking admission to Welingkar’s Hybrid Management Programs have read the prospectus thoroughly
and understood all the rules and regulations described therein and agree to abide by the same.
6) It is the student’s responsibility to ensure that their contact details such as address for communication, e-mail id, mobile no. etc, maintained
by the Institute remain updated and current for the duration of the program.

Signature of Student Executive Name

Date 26th March 2021 Executive Signature

Verified by : Branch Stamp

(Sign of Branch H.O. Executive)