ACCMAN INSTITUTE OF MANAGEMENT
46A/2, Knowledge Park-III, Greater Noida-201308  
Ph: 0120-2323800-02; Mob: 9873076521/22
Application Form - PGDM (2011-2013)
 
Full Name Mr/Ms
Date of Birth (DD-MM-YYYY)
Address
E-mail ID
Correspondence postal address (IN CAPITALS) (Do not repeat name)
Tel No.

Family Details
Father’s/Husband’s Name
Profession/ Business
Designation
Name of Organisation
Office Address
Office Tel No.
Are you an NRI? Yes     No    
Are you an employed? Yes     No   
If yes, since when? month Year    to month year
Name and address of the Organization
Your Designation Total Experience (No. of Yrs.)
Do you require hostel accommodation? Yes    No
Academic Qualification (Tenth Standard onwards)
Examination/Course (Mention Stream of Study) Science, Commerce/Arts/Engg. Pharmacy)
Year of Passing
School/College Attended
Board/ University/institution
% of marks obtained/grade
Area of Specialization / subjects, if any
Class X      
Class XII          
Graduation          
Any other          

(Attested copies of mark sheet of the degree / graduation should be enclosed with the application form)
Special Achievements (If Any)
Extra Curricular Activities/Hobbies
Admission Test: ATMA     CAT     MAT     XAT
Any Other Percentile


Attach photocopies of the following certificate and tick the appropriate boxes
H.SC. Pre-degree Marks Sheet   UG Degree of Provisional Certificate   Entrance Test Score Card
Work Experience Certificate if any   Registration Fee   Any other
Declaration by applicant
I,  the undersigned, affirm that the information furnished above is correct to the best of my knowledge and belief, and that I will accept as final and binding, the decision of “ACCMAN INSTITUTE OF MANAGEMENT” regarding my admission . If any information provided by me is found to be false or incorrect at a later date, I will be held solely responsible for the legal and other consequences. I hold my self-responsible for the dues and prompt payment of fees, if selected. I have noted that fees once paid are not refundable, under any circumstances.
Place: Signature:
Date: Name:
Declaration by Guardian/Parent
I hereby vouch for what has been stated above my son/daughter/ ward in respect of his/her enrolment at the Accman Institute of Management.
Place: Signature:
Date: Name: