MANAGEMENT DEVELOPMENT INSTITUTE, GURGAON

PERSONAL DETAILS FORM (PGP 2019-21 Batch)

Please fill in Block Letters

CAT Registration Number ________________________________________

Name ________________________________________

Father’s/Mother’s Name _________________________________________

Affix a recent
Contact Number 1_________________2._____________________ passport size
photograph
E-mail id _________________________________________

Programme Preference (PGPM / PGP-HRM / PGP-IM */ NA)

Programme Preference 1 : ____________

Programme Preference 2 : ____________

Programme Preference 3 : ____________

*The eligibility criteria for PGP-IM is minimum of 1 year (one-year) of work experience post-qualification
(Minimum of 4-year's Bachelor's degree) on the last date of application.

Please tick () wherever applicable

Female Male

Declaration
I, _________________________________________, certify that I satisfy the eligibility requirements for this
programme and that all entries made in this application form, are true to the best of my knowledge and belief.
I am willing to produce original certificate(s) in support thereof if asked to do so at any stage during the course.
I agree to abide by decisions of Management Development Institute on all matters regarding this application.

Date :
Place

(Signature)

1
Academic Qualification:

Degree with
Name of the Name of the Board / Year of Total Marks/ Stream (Engg.
Qualification Institution/Professional University Completion Obtained / Science /
Body State / UT Marks/Percentage Commerce /
Art / etc.)
Secondary
English
School (X)

Hindi/ Second
language

Mathematics

Social Studies
Science

Sr. Secondary
English
School (XII)
Subject 1

Subject 2

Subject 3

Subject 4
Graduate
Degree(Duration
min. 3 years)
Post-Graduate
Degree

Professional
Degrees

Work Experience

(Furnish details of a maximum of THREE (use a separate sheet in case you want to mention more) full-time jobs starting first with
The present job (excluding training periods) engaged in, after completion of Bachelor’s Degree)

Period from Emoluments per Turnover of

Name of
Designation Nature of Duties – To annum (in Rs. Organization
organization
dd/mm/yy Lacs) (in Rs. Lacs)

Total Post Qualification Work Experience (in YEARS-MONTHS) (as on 31st December 2018: _______________