SIESCollegeofManagementStudies

SriChandrasekarendra SaraswathiVidyapuramPlot1E, SectorV, Nerul,Navi Mumbai–400706Tel:(022) 61082400 Fax:022-27708379

Website:

Contact name &number:Prof. Vilas K. Chaudhari

08805812166 ; 7738828132 ; 022- 61083469

APPLICATIONFORM

FORADMISSIONTO

POST GRADUATE PROGRAM IN BUSINESS ANALYTICS (PGP – BA)

BY AIMA & SIESCOMS

(TobefilledbytheSIESCOMSAdmissionOffice)ApplicationNo:

AffixPhotograph

Pleasesignacross

thephotograph

STUDENTCONTACTINFORMATION

1.Fullname(blockletters)
(asperdegreemarksheet):
2.DateofBirth):
3.Gender: / 4.MaritalStatus / :
5.Nationality: / 6.Mother Tongue / :
7. TelMobileNumber:
8.Email:
9.ResidentialAddressforCorrespondencewithPinCode:
Telephone Residence
: ______Mobile :______

A.ACADEMICQUALIFICATIONS

NameoftheSchool/College / University / MonthandYearofPassing / PercentageofMarks
Graduation
Post-Graduation

N.B.: Pleaseprovidetheself attestedphotocopiesoftheabovementionedcertificatesalongwiththeapplicationformandtheoriginalofthesameshouldbesubmittedatthetimeofsecuringadmission.

B.WORKEXPERIENCE

NameoftheOrganization / Tenure / No.ofMonthsWorked / PositionHeld
From / To

ENCLOSURES

(i) / Proofofage(DateofBirthCertificate/SSCCertificate/SchoolLeavingCertificate) / -Attestedphotocopy
(ii) / MarkssheetPassingCertificateofDegreeexaminationpassed.Studentsawaiting finalyearresult
dsubmitMarksheetsofallearlieryears. / -Attestedphotocopy
(iii) / WorkExperienceCertificate / -Attestedphotocopy

Ideclarethatalltheparticularsprovidedbymeabovearetrue.

Signature: Place: Date:

  • TheApplicationFormscanalsobesubmittedin person or by post/courier.
  • PleaseaffixcurrentphotographsontheApplicationFormandsignacross.
  • All certificates should be self attested.

PleaseNote:AlldisputesunderMumbaiJurisdiction