P-2

Application Form for Management Programmes (MBA-IT Enabled Services Management)Fill relevant details of valid all India level proficiency scores (as applicable)*

CAT Registration No.CAT Percentile/score

CMAT Registration No.CMAT Percentile/score

MAT Registration No.MAT Percentile/score

* Please attach an attested copy of score. Choice of Centre (for group discussion and personal interview of short listed applicants, however Institute has discretion to change the centre)

Gwalior New Delhi

Applicants Information (Fill relevant details or tick appropriately)

1Name of Applicant

2SexMaleFemale

3Date of BirthDD/ MM /YYYY

4Category SCSTPHOBCGeneral

5Fathers/Mothers/Guardian Name

6Address for Correspondence

City

PIN

State

7E-Mail@

8Mobile Phone

9 Online Fees Transaction ID Number

10.Date DD/ MM /YYYY

Educational Qualifications (Please check your eligibility as per admission notice and indicate your degree clearly)

#Examination Board / UniversityYear of Passing% of Marks / CGPADiscipline Mathematics / Statistics as a Subject (yes/no)

1SSC (10th)

2HSC(12th)

3Bachelors

4Masters

5Others (Specify)

Work Experience

#Name of OrganizationPost HeldJob DescriptionDuration

One set of attested/self attested photocopy of all the supportive documents as given in below check list must be attached along with hard copy of completely filled-in/typed application form.Check-List

aMark-sheet of all examinations passed (where grades are awarded the equivalent of the grades and the corresponding percentage duly countersigned by the Concern Authorities of the Institution / University should accompany Grade Cards.)YesNo

bConversion formula if results were in the form of Grades/CGPAYesNo

cValid CAT/CMAT/MAT ScoreYesNo

dProof of Date of BirthYesNo

eSC/ST/OBC (non creamy layer) /PH Certificate YesNo

fOnline Fees Transaction ID receiptYesNo

NOTE: Your application will not be considered if not accompanied by appropriate certificates and documents or received after the last date of submission.UNDERTAKING BY THE CANDIDATE

a) I hereby certify that the foregoing particulars are correct and I agree that admission may be granted to me on the terms, conditions and rules of the ABV-IIITM Gwalior or such modifications thereof as may be made by authorities concerned from time to time. I understand that my admission may be cancelled and tuition fee paid by me forfeited if any of the particulars given by me in this application form are subsequently found to be wrong.

b) I agree that the institute decision in all matters concerning my admission, studies, discipline and conduct will be final and binding on me.

c) On admission, I undertake to submit myself to the disciplinary jurisdiction of the institute according to the rules of the institute.

d) I understand that my association, active or passive, with any unlawful organization is forbidden.

e) I certify that I am not registered as a provisional or otherwise student of any other institute.

Place: .

Signature of the ApplicantDate: ..

Name:ATAL BIHARI VAJPAYEE

INDIAN INSTITUTE OF INFORMATION TECHNOLOGY & MANAGEMENT GWALIOR

(AN AUTONOMOUS INSTITUTE OF GOVT. OF INDIA)

Website: www.iiitm.ac.in

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