Form No: GLBIMR/2024

Institute of Management & Research. PGDM Institute

Greater Noida

FIND YOUR SPAR K

GL Bajaj Institute of Management & Research. PGDM Institute

(Approved by AICTE, Ministry of HRD, GOI, AIU (Equivalent to MBA) and Accredited by NBA)

Plot No. 2, Knowledge Park-III, Greater Noida, U.P. - 201306

E-Mail: admissions@glbimr.org | Website: www.glbimr.org | Helpline No.: 8010-081-081

Selection Process / Registration Form

Entrance Exam Scores: Affix your

recent passport
CAT Score ............. / Percentile ............... MAT Score ............. / Percentile ............... size colour
photograph
XAT Score ............. / Percentile ............... CMAT Score ............. / Percentile ...............

ATMA Score ............. / Percentile ............... GMAT Score ............. / Percentile ...............

STUDENT PARENTS DETAIL

DETAILS
Name of the Student in Full (Block Letters): Father Name and Contact:

Permanent Address:
Mobile:

Mother Name and Contact:

State PIN

Res. Telephone No.: Mobile:

Mobile:
Correspondence Address (if different from Permanent Address):

Guardian Occupation:

State PIN
Annual Income in Rupees:
Res. Telephone No.: Mobile:

Email ID: Aadhar Card No.:

National Academic Depository ID (NAD ID): Nationality:

Date of Birth: Gender: Religion: State of Domicile:

Category: General SC/ST OBC Minority Others

 ACADEMIC
QUALIFICAITON
Qualification Board/Univ. Roll No. Stream Passing
Year Mark Obtained/Total Marks

High School OM ............. / TM ............... ...........%

Intermediate OM ............. / TM ............... ...........%

Graduation OM ............. / TM ............... ...........%

Post Graduation OM ............. / TM ............... ...........%

Others OM ............. / TM ............... ...........%

WORK EXPERIENCE (if any)

Organisation Designation D.O.J D.O.L Experience (Yrs & Mo.)

Total Experience:

Student Declaration

• I hereby declare that the particular stated above are true to the best of my knowledge.
• The admission is purely provisional subject to fulfilling and verification of all the certificates and statements made by
me in the admission form and in compliance with the AICTE requirements. In case my admission is not approved or
cancelled by the Competent Authorities, then the Institute will not be liable for the same and I will not claim any fee
refund.
• I have read and understood all the rules and regulations of the Institute. I will fully abide by the rules and regulations of
the Institute during the course of my studies, otherwise my admission can be cancelled, or any other disciplinary action
can be taken against me.
• I hereby undertake that I will produce my proof of qualifying examination as required by the institute, by 30th
September ................... In case, I will not produce my proof of qualifying examination by the stipulated time, my
candidature may be considered null and void and shall not claim any refund of fee/registration amount deposited by
me.
• I hereby undertake that: If I withdraw my admission (whatever the reason) after the last date as prescribed by AICTE, I
shall not be eligible for refund of fee and even not claim for refund of fee in the Institute.

Date: Student Signature Parent Signature / Legal Guardian