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REGISTRATION DETAILS
The symbol (*) indicates mandatory fields.

Personal Details
Salutation This is a mandatory field.� Please select the appropriate option.
First Name * If your name is Kshitij Mathur, then �Kshitij� is the first name, and �Mathur� is the second name. If you do not usually use a middle name or do not have a middle name, just leave the field blank.
Middle Name If you have a middle name please fill in your middle name. For example if your full name is Siva Rajkumar Raghunathan, then� fill in �Rajkumar� as the middle name.
Last Name* Last name/Surname or family name. This may often be your father�s name or a common last name in the family.
Date of birth* The format is dd-mmm-yyyy (e.g.19-Feb-1981)
Gender�* Simply click the relevant button.���
Nationality * Select your nationality from the drop down.
Upload Photo(Only .jpg or .jpeg or .gif formats, Upto 100 KB)
Upload Photo Upload your recent photograph.
Present Address
Present Address Line 1 * Enter your door number, apartment number in the address line 1 field.
Address Line 2 Enter your street address.
Address Line 3 Enter your locality name.
City * Enter the city where you are located at present.
State * Select the state where you are located at present.
Country * Enter the country name.
Pincode * Enter your area pincode (Note: Fill only numeric characters only (0-9). Do not leave spaces in between).
STD Code* Enter the STD code city (For e.g. 0444234522). Phone Number (With STD Code) * Enter the code and phone number of your city (For e.g. 0444234522).
Mobile Number * Enter your mobile number.
Fax If you have any Fax number please fill it in this column.
Primary Email * Please enter the email address.For e.g. [email protected]. Do not use anyone else�s email address.
Retype Primary Email * Please retype the Primary Email ID.
Alternate Email Please enter the alternate email address.
Retype Alternate Email Please retype the Alternate Email ID.
Is Permanent address same as Present Address If the answer is YES, please indicate. If the answer is NO, you will have to fill in your permanent address in the fields that appear.
Permanent Address Line 1 * Enter your door number, apartment number in the address line 1 field.
Address Line 2 Enter your street address.
Address Line 3 Enter your locality name.
City * Enter the city where you are located at present.
State * Select the state where you are located at present.
Country * Enter the country name.
Pincode * Enter your area pincode (Note: Fill only numeric characters only (0-9). Do not leave spaces in between).
PDGM Programme Preferences
Preference 1 * Select Appropriate option
Preference 2 * Select Appropriate option.
Preference 3 Select Appropriate option.
Details of Entrance Test
Name of the Entrance Test* Enter name of exam if any.
Test Date (e.g. 22-Apr-2013)* Enter the date of Exam here.
Roll No./OMR No Enter the Roll No./OMR No.*
Score* Enter your score in Exam.
Percentile* Enter your Percentile of exam.
Family Details
Name of Father* Enter your Father name.
Occupation Select the occupation of your Parent / Guardian from the drop down.
Office Address Specify the Current address of your Father.
Phone Number* Specify their Office Telephone number preceeded with the STD code.
Email Enter the email address of your Father.
Name of Mother* Enter your Father name.
Occupation Select the occupation of your Parent / Guardian from the drop down.
Office Address Specify the Current address of your Father.
Phone Number* Specify their Office Telephone number preceeded with the STD code.
Email Enter the email address of your Father.
Family Annual Income Enter the Family Annual Income.
Educational Details
X
School Name Enter the name of the school you studied in.
Board / University Name* Specify the Board / University.
State* Enter the state.
Year of Passing * Select the year of passing from the drop down.
Percentage Scored * Enter your overall percentage.
Main Subjects Enter your major subjects.
Mode of Study* Select the mode of study from the drop down provided.
XII
School Name Enter the name of the school you studied in.
Board / University Name* Specify the Board / University.
State* Enter the state.
Year of Passing * Mention the year in which you passed.
Percentage Scored * Enter your overall percentage.
Main Subjects Enter your major subjects.
Mode of Study* Select the mode of study from the drop down provided.
UG Degree
Examination type * Select the relevant option.
Name of degree * Enter your degree.
College Name Enter the college you studied in.
Board / University* Enter the Board or University.
State* Enter the state.
Year of Passing* Mention the year in which you passed.
Major Subject / Discipline * Enter your major subjects.
Mode of Study* Select the mode of study from the drop down provided.
Total Aggregate % * Enter your overall percentage.
PG Degree
Do you have PG Degree * Select the relevent option.
Type Of Degree * Select the relevant option from the drop down.
Name of degree * Enter your degree.
College Name Enter the college you studied in.
Board / University Enter the Board or University.
State Enter the state.
Year of Passing Mention the year in which you passed.
Major Subject / Discipline Enter your major subjects.
Mode of Study Select the mode of study from the drop down provided.
Total Aggregate % *
1 Year (%/CGPA)* Enter your 1st year percentage.
2nd Year (%/CGPA)* Enter your 2nd year percentage.
Employment History
Do you have Work Experience * Select the relevant option from the drop down.
Name of the Organisation* Enter your Organisation Name.
From Month/Year * Select the date when you joined the organisation.
To Month/Year * Select the date till you worked in the organisation.
Designation* Mention your designation in the organisation.
Work experience in Months Specify your total experience in months.
Other Details
Academic interest and purpose of study * Not exceeding 1000 characters write about your academic interest and purpose of study.
Please account for break in your academic career, if any * Not exceeding 1000 characters write about your account for break in your academic career, if any.
Statement of Purpose (Please type in 200 words your reason for joining our PGDM Programme) * Enter Statement of Purpose (Please type in 200 words your reason for joining our PGDM Programme)


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