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Application Form

INDIAN INSTITUTE OF TECHNOLOGY DELHI Department of Management Studies Admission to MBA (2 Year Full Time) 2014-16

ONLINE APPLICATION FORM

APPLICATION NUMBER CAT. REGISTRATION NO. OVERALL CAT PERCENTILE PREFERENCE NAME OF THE CANDIDATE NAME OF THE PARENT /GUARDIAN RELATIONSHIP OF PARENT/GUARDIAN TO THE CANDIDATE ADDRESS FOR CORRESPONDENCE 302812 SR9283801 98.52 1.DLM 2.DLT JUJARU KRISHNA SASHANK J CHANDRA SEKHAR Father PLOT NO 10, FLAT GA, SAI VASAVI ENCLAVES, OLD VASAVI NAGAR, KARKHANA, SECUNDERABAD H NO 79/14-B/A, KRISHNA NAGAR KURNOOL Candidate Signature STATE / UT PIN CODE EMAIL DATE OF BIRTH NATIONALITY CATEGORY PERSON WITH DISABILITY GENDER Andhra Pradesh 500015 sashankjujaru@gmail.com 23/10/1989 Indian OBC NO Male DETAILS OF THE DD ENCLOSED DD AMOUNT 1000 DEMAND 279105 DRAFT No. DATE OF DD 27/01/2014 STATE BANK OF BANK NAME INDIA LANDLINE PHONE MOBILE NUMBER 7200364944 CANDIDATE PHOTO (3cm x 4cm)

Academic record (in chronological order starting with the most recent examination) Examination Discipline / Subject Passed B. Tech Electronics And Communication Engineering University / Board School / College Year of % Of Aggregate passing Marks or CGPA Sri Krishnadevaraya University G Pulllareddy Engineering College Narayana Junior colllege Sri Raghavendra Vidya Sadan 2011 75.31

Board of Intermediate Maths,Physics,Chemistry Intermediate Education, AP X class Board of Secondary Education, AP

2007

96.60

2005

87.00

Details of the latest work experience , if any (Start with the most recent one) Period 15-Mar-2012-Till date Designation Assistant System Engineer Organisation Tata Consultancy Services G Pullareddy Engineering Remark Software Engineer

26-Jun-2011 to 31-Octhttp://gate.iitd.ac.in/dms2014/online3.php

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1/27/2014 26-Jun-2011 to 31-Oct2011

Application Form
Assistant Professor G Pullareddy Engineering College Lecturer

Total work experience (year , month ) : 2 year(s) 2 month(s)

Reason for joining the program (150 words only) : I had a work experience of entry level associate from past two years. Now I want to explore the Managerial space. To achieve this I have to undergo through a course. An MBA course from a premium college will help me in bringing manager out of me. This course will help me in building my career and will lay the path to reach my goal. The college brand will add value to my profile.

DECLARATION BY THE CANDIDATE: I hereby declare that all the particulars furnished in this Application Form are true to the best of my knowledge and belief . I have read the online information and I shall abide by the terms and conditions therein. In the event of suppression or distortion of any fact in my Application Form, I understand that I will be denied the opportunity to appear in the admission process. Further, if any such suppression or distortion of facts is discovered after appearing in the admission process, any admission/degree acquired on the basis of the score is liable for cancellation.

Signature of the Candidate (with date):_____________________________________________

FOR OFFICE USE ONLY

(Recommendation / observations of the office) The candidate may be provisionally admitted / not admitted subject to the following: 1) Production of attested copies of the qualifying degree certificate and marks sheet showing the required % of marks/CGPA by 21.07.2014 2) Production of proof from the University/ Head of the Institution of having appeared/passed in the qualifying Degree Examination by 21.07.2014. 3) Production of relieving certificate from Employer by 21.07.2014. 4) Production of Attested copy of OBC/SC/ST/PH certificate by 21.07.2014. ----------------------------------------------------------------------------------

DR(PGS & R)

OS (PGS & R)

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