Online Application form for Admission to MBA course in Institute of Management & Technology Punnapra under CAPE for 2011-2012 Please go through the Instructions before filling up this form Name of Candidate (Initials must be at the end)* Date of Birth* Day   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    Month  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec    Year  1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000   Age* Religion Nationality Caste/Community Sex*   Male Female Name of Father//Guardian* Occupation Name of Mother Occupation Address for communication   House Name/No. * Place* City/District, Post Office* Pin Code*   Permanent address (Same as above    )   House Name/No. *   Place*   City/District, Post Office*   Pin Code*   E-mail id   Contact number     STD Code Telephone* Mobile   Annual Family Income   Whether belong to SC/ST (Specify Yes or No) No Yes   Details of qualifying examination     Degree*:   Subject /Branch   University : Month & Year of Passing Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010   Details of marks secured in the qualifying examination a. Three-year degree graduates : Specify Subject/Specialisation Part of Examination Maximum marks Marks Percentage Part I   Part II Part III   Grand Total b. Four-year degree graduates(Professionals & Others):   Specify Subject/Specialisation Maximum marks Marks Percentage Grand Total           General Academic Profile from S.S.L.C and after Examination passed Specialisation/Major subject Institution/College University/Board Percentage S.S.L.C Plus 2 / P.D.C Degree Post Graduation Any other Details of work experience (if any) Organisation Designation/Nature of Job Duration(Years /months)       Mention your achievements (if any) in Extra currcular actives Sports Arts Literary activites Leadership positions held NCC / NSS Any other Mention your hobbies (if any)       Declaration I do hereby affirm that all the particulars furnished above are true to the best of my knowledge and belief and that I shall abide by the rules and regulations for admission to M.B.A course in Institute of Management & Technology Punnapra under the Co-operative Academy of Professional Education, CAPE I agree*