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Online Application Form 2021 - Application

Registration Number 21IM1768

Application Number OP21WM0073

Course Applied for MBA - WMSE

Applied Date 28/07/2021

Personal Interview
COIMBATORE
Centre
 
Name of the Candidate SIVASUBRAMANIYAN

Date of Birth 14/09/1998

Gender Male

Community FC

Do you have Passport? Yes

Are you going to appear

No
TANCET?

1. Test Details

Test Score Information

MAT CMAT CAT ATMA TANCET GMAT

Month & Month & Month & Month & Month & Month &
Score Score Score Score Score Score
Year Year Year Year Year Year
Jun 2021

English Score Information (applicable for UT & HOF)

Mat (Language) TOEFL IELTS Month & Year

7.0

2. Academic Qualifications

2.1  SSLC

Board TAMIL NADU

Name of the School Velammal

Year of Passing 2014

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Percentage of Marks
Obtained - Aggregate 96
(##.#)

2.2  H Sc

Board TAMIL NADU

Name of the School Velammal

Year of Passing 2016

Percentage of Marks
Obtained- Aggregate 85
(##.#)

2.3  Graduate Degree

Stream B.Sc     Major Computer science

Mode of Study Full Time

Actual / Expected Year

2019
of Completion

Name of the College The American College

Name of the Univeristy Madurai Kamaraj University

Percentage of Marks
66
(##.#)

2.4  Post-Graduate Degree (if applicable)

Stream     Major

Mode of Study

Actual / Expected Year

of Completion

Name of the College

Name of the Univeristy

Percentage of Marks
(##.#)

3. Employment History

Do you have work

No
experience?

4. Personal Details

Father's Name Thirugnanasambandam Occupation Self Employed Mobile 8870800415

Mother's Name Vallinayaki Occupation home maker Mobile

Guardian's Name Occupation Mobile

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5. Address for Communication

House Number NO 90 BHARATHI NAGAR 2ND STREET ,

Street KRISHNAPURAM COLONY

City MADURAI

State TAMIL NADU

PIN Code 625014

Phone -

Mobile 9500779162

E-Mail (which you

sivasam1404@gmail.com
access on daily basis)

Undertaking by Candidate

I have gone through the prospectus and the Rules & Regulations of the Institute. I declare that all the above information
provided by me on this application form and supporting documents are correct to the best of my knowledge and belief.
In case of any change in the given information, I will notify the same to the institute immediately. If the information is
found incorrect at any stage, I will be responsible for the same and the Institute may take action as deemed fit.

Disclaimer

Instances of provision of incorrect information detected at any stage of the selection process will lead to disqualification
of the candidate from the selection process and admission shall be cancelled by PSG Institute of Management. If such
instances go undetected during the current selection process but are detected in subsequent years, such disqualification
will take place with retrospective effect.

Signature of the Canditate

(Signature not needed in case of online application)

------------------------------------------- Tear Here (for your reference) -------------------------------------------

Course Applied
Application No. OP21WM0073 PSGIM - MBA - WMSE
for
Name of the Canditate SIVASUBRAMANIYAN Mobile 9500779162
Personal Interview
COIMBATORE E-mail ID sivasam1404@gmail.com
Centre
Applied Date 28/07/2021 Amount Rs. 1000

Payment Transaction Id OA217697 Payment Status Success

Bank Reference No. 71727353355    

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