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M M B C APPLICATION FORM FOR ADMISSION TO POST GRADUATE PROGRAM IN 2 0 0 8 A A MASTER OF BUSINESS ADMINISTRATION (MBA) M.E. / M.Tech / M. Arch
KARNATAKA PG CE T
GOVT. OF KARNATAKA
Application No. :
POST GRADUATE COMMON ENTRANCE TEST - 2008
M BA
USE
PGCET RANK
1. TEST PLACE :
(See Test Places on page 2) (in block Letters as per Degree Marks Card)
OF F I C E
2. COUNSELING PLACE: (Tick only one)
O FF IC E US E
BANGALORE
BELGAUM
Seat No.:
0 8 M B A
Affix recent colour photograph for scanning
3. FIRST NAME :
MIDDLE NAME :
LAST NAME :
25 mm x 35 mm size
4. Course applied for (Tick
5. Have you applied for PGCET 2008 MCA Test also?
M M 6. Date of Birth : D D 8. Correspondance Address : Y Y Y Y
P the appropriate box) :
Part time Yes
Full time No F 7. Sex : M
Both
Signature of the candidate for scanning
PIN : Phone (STD code) E-mail ID : 9. Domicile as per Definition 2(a) in Brochure (Tick 10.Category :
(applicable to Karnataka students only) (Tick the appropriate box)
Test Centre :
Cell No.
OFFICE
USE
P the appropriate box) : Karnataka
ST I IIA
Non Karnataka IIB
GM
SC
11. Qualification Details :
Sl. Particulars of No. Examinations passed
P
IIIA IIIB Phy.H. Ex-serviceman Degree:_____________________ Branch/Stream:_______________________________
Month & Year of passing *Max. Total M arks *M arks Obtained Remarks
Name of the University with place
1 2 3 4
I Year II Year III Year IV Year
/ / / /
I Semester II Semester III Semester IV Semester V Semester VI Semester VII Semester VIII Semester
*Total Marks & Marks obtained should include Optional & Languages also. TOTAL Note : If results are awaited for particular semester/year indicate “RA” in Remarks column.
12. DD Details: Amount:_________ DD No.:_____________ DD Date:______________ Name of the drawee Bank: 13. DECLARATION BY THE CANDIDATE
1. I declare that all the information given by me is true and authentic to the best of my knowledge and belief. 2. I have read the instructions carefully and agree to abide by the rules and regulations of admissions. 3. I am fully aware that INCOMPLETE APPLICATION will be rejected by PGCET Cell.
% Marks
Eligible Not Eligible Result Awaited OFFICE Verified by :
(Sign. & Date) 1. ________________________ 2. ________________________
PLACE : DAT E:
Signature of the Candidate
ENCLOSURES CHECK LIST
Attested copies of : Statement of marks : 1) S.S.L.C. 2) P.U.C. / 10+2 / equivalant (specify) 3) Degree (All the years in full). Study certificate for 7 years of study in Karanataka (See Definition 2(a) in Brochure). Income certificate, if claiming admission under reserved category. Authentic documents certified by the Tahasildar / Competent Authority for claiming admission under reserved category. Document in proof of Date of Birth. Experience Certificate (Minimum 3 years), if applying for Part Time
USE
ANNEXURE-STUDENT POSTAL ADDRESS FOR POSTING ADMISSION TICKET
KARNATAKA PG CE T
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To,
M B A
M C 2 0 0 8 A M.E. / M.Tech / M. Arch
PIN
From, The Member Secretary, CPAC & Registrar, Visvesvaraya Technological University, “Jnana Sangama”, Belgaum - 590 018 Karnataka State.
Cell / Phone No
FOLLOWING PAGE TO BE RETAINED BY THE STUDENT
TEST PLACES
Choose any one of the following places where you wish to appear for the test
1 2 3 4 5 BAGALKOT BANGALORE BELGAUM BELLARY BIJAPUR 6 7 8 9 DAVANGERE DHARWAD GULBARGA HUBLI 10 11 12 13 MANGALORE MYSORE SHIMOGA TUMKUR
IMPORTANT NOTE : 1. An original Demamnd Draft (DD) of Rs. 600/- (Rs. 300/- in case of Karnataka SC/ST & Cat-I on production of documentary proof) in favour of member Secretary, CPAC, payable at Belgaum, should be sent along with each Application form. Write
your NAME and ADDRESS on the backside of the Demand Draft.
2. Application forms for MBA and MCA courses are seperate. Candidates who wish to apply for both should apply seperately with all enclosures specified attached with each application A xerox copy of the completed application form and a
Demamand Draft may be kept with candidate for future reference.
3. Write your complete postal address in ANNEXURE-STUDENT POSTAL ADDRESS above to enable PGCET to send a copy of the brochure and Admission Ticket to you. 4. DO NOT WRITE IN THE SHADED AREAS OF THE APPLICATION FORM, IT IS MEANT FOR OFFICE USE ONLY. 5. The Candidate will be allowed to write the test, Only on production of the Admission Ticket. 6. Admission Ticket, Provisional Admission Order and receipt for the fee paid at PGCET cell are ESSENTIAL and should be produced for taking admission in the allotted college. 7. For detailed information about counseling centres and merit list visit www.vtu.ac.in / pgcet.vtu.ac.in. For any clarification contact at 0831-2498126 or 0831-2498127 8. The following should be sent to the address below on or before: 24/05/2008 (Write MBA or MCA as applicable on the envelop) Completed APPLICATION FORM with all enclosures D.D of Rs. 600/- ( Rs. 300/- for Karnataka SC/ST/Cat-I candidates only) ANNEXURE-STUDENT POSTAL ADDRESS
TEST PLACES ADRESS FOR OFFICE CORRESPONDANCE The Member Secretary, CPAC & Registrar, PGCET CELL, Visvesvaraya Technological University, “Jnana Sangama”, Belgaum-590 018, Karnataka State.