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8/7/2019 rmat form
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Caution : [Use "PAYFEE" Menu option only] Page 1/2Course: MBA AND PGDM
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Course: MBA AND PGDM||
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Course:MBA AND PGDM
Reg. No. 115153 Reg. No. 115153 Reg. No. 115153Bank CopyINSTITUTE ID - RMT11
Date: - - 2011
Punjab National Bank
RMAT - 2011
Candidate'sName :
VISHAL KUMARBANSAL
Father'sName :
SURESH KUMARAGARWAL
Mobile No : 9166346675
Application Fee : 1000Bank Charges: 10Total Fee: 1010
Denomination Rs1000 x500 x100 x50 x20 x10 x5 x
(Rupees One Thousand TenOnly)
TXN NO. :
Branch Name and Code:
Rubber Stamp of Banker
Signature of the Candidate
Non refundable
RMAT Office CopyTo be attached with Confirmarion Page
Date: - - 2011
Punjab National Bank
RMAT - 2011
Candidate's
Name :VISHAL KUMARBANSAL
Father'sName :
SURESH KUMARAGARWAL
Mobile No : 9166346675
Application Fee : 1000Bank Charges: 10Total Fee: 1010
Denomination Rs1000 x500 x100 x50 x20 x10 x5 x
(Rupees One Thousand Ten
Only)
TXN NO. :
Branch Name and Code:
Rubber Stamp of Banker
Signature of the Candidate
Non refundable
Candidate Copy
Date: - - 2011
Punjab National Bank
RMAT - 2011
Candidate's
Name :VISHAL KUMARBANSAL
Father'sName :
SURESH KUMARAGARWAL
Mobile No : 9166346675
Application Fee : 1000Bank Charges: 10Total Fee: 1010
Denomination Rs1000 x500 x100 x50 x20 x10 x5 x
(Rupees One Thousand Ten
Only)
TXN NO. :
Branch Name and Code:
Rubber Stamp of Banker
Signature of the Candidate
Non refundableBank Spoc :9828365283
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Page 2/2
RMAT - 2011Application Form (Confirmation Page)
Form No. 115153Exam. Fee 1000
1. Choice ofExamination Centre and CourseCourse :MBA AND PGDM
I. 105 - JAIPUR
II. 107 - JODHPUR2. Name of Candidate: VISHAL KUMAR BANSAL3. Father's Name : SURESH KUMARAGARWAL4. Mother's Name: MADHU BANSAL5. Address: 2B-22 RAJASTHAN HOUSING
BOARD,COLONY
SIROHI-307001
6. District: SIROHI
7 State: RAJASTHAN
8. Mobile No.: 9166346675 9. Phone No.:10.Date of Birth: 26-01-1991 11. Sex: MALE
12.E-mail: [email protected]: GEN 14. Sub-Category: NONE15.State of Bonafied
Residence :Rajasthan 16. Domicile Category : A
17.Qualifying Exam :
Detail Subject/Stream Board/University Year Max.Marks
Marks
Obt. %
Secondary RBSE 2006 600 400 66.67Sr. Sec. SCIENCE RBSE 2008 650 365 56.15
Apearing for UG Finalyear exam YESU.G. BBA RAJASTHAN UNIVERSITY 2011
DeclarationI VISHAL KUMAR BANSAL declare that I have read the rules and the eligibility criteria for RMAT-2011 given in its information Brochure. Ifurther declare that the information given by me in this application is true and completed in all respects to the best of my knowledge and
belief. I understand that the suppression of factor giving false information may lead to cancellation of this application. I undertake that if I amfound to have concealed/ distorted any material and information or ineligibility detected an any time before or after admission, my admission
shall be liable to be summarily cancelled without any further notice. I know fully well, that I cant join any other course so long as I am MBAAND PGDMstudent and if it is found that I have joined any other course simultaneously, my admission to MBAAND PGDM shall stand
cancelled.
Place :
Date :Full Signature of Applicant
(in the box)CHECK LIST
(Note : Incomplete forms are liable to be REJECTED without notice)(Tick mark the relevant entries)
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1. Completed all entries in the On Line Application Form
2. Paste Your Passport Size photograph if you have not uploaded it online.
3. Attached copy of proof ofDomicile of Rajasthan.
4. Attached copy of proof ofSecondary Certificate(10th).
5. Attached copy of proof ofSenior Secondary (10+2) Examination.
6. Attached copy of proof ofGraduation OR appearing in final year of graduation(ifAppearing in 2011)
7. Attached copy of proof ofCategory (SC/ST/OBC/SBC/PH/EX-S/KM).
8. Signed the confirmation page.
9. Spare photograph (Form No. & Name metioned backside) stapled with this form.
POSTAL ADDRESS :COORDINATORRMAT- 2011, M. L. V.TEXTILE & ENGINEERINGCOLLEGE, PURROAD, BHILWARA- 311001(RAJ.)
