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InstituteofManagementinKerala

UniversityofKerala
UniversityCampus,Kariavattom,Thiruvananthapuram695581.

APPLICATION
MBA(General)and(Tourism)CSSFulltimeProgramme20132015.

SerialNo.

Feeremittedparticulars
Payinslip/DDNo
AmountRs..
Date:..

Reg.No.
(forofficeuse
only)

1.
2.
4.
6.
8.
9.

NameinFull
Affixastampsize
DateofBirth.3.Age..
photo
Nationality.5.Placeofbirth.
Religion.7.Community.
StatewhetheryoubelongstoSC/ST/OEC..
AreyoueligibleforreservationunderthefollowingcategoryaspertheG.O.
(MS)No.108/2008/H.Edn.dated20.9.2008.

Ezhava

Muslim

LC/SIUC

OBC(christian)

OBC(Hindu)

Physically
handicapped

SportsQuota

BPL(Forward
communityonly)

10. Addressforcommunication:.
..

PinPhone..MobileE.mail..


11. PermanentAddress:...
..
.PinPhone.
12. NameandoccupationofParent/Guardian
13. Detailsofthequalifyingexaminationpassed:
A:DegreeB.Branch/Subject.C.University
D.Month&yearofpassing..
E.Division/Class..D.percentageofmarksinaggregate.
14.Detailsofmarkssecuredinqualifyingexamination(specifythesubject/Specialisationalso)
Qualifying
Examination

PartsofExamination
BA/B.Sc/B.Com

Max.Marks

Semester
courses

Markssecured

%ofmarks

GrandTotal

15. Detailsofworkexperience,ifany(Teaching,Research,IndustrialEtc.)
Organisation

Designation&Natureofwork

Period

Declaration

Iherebysolemnlyandsincerelyaffirmthatthestatementsmadeandtheinformation
furnishedintheapplicationformsubmittedbyme,aretrue.
Place:Date:SignatureofApplicant.

CHOICEOFENTRANCEEXAMINATIONCENTRE
(ChooseonlyoneCentreofyourchoice.TheUniversityreservestherighttocancelanycentreiftherearenosufficientcandidates.In
caseifyourcentreiscancelled,acentrewillbeallottedbyUniversity).

1.Thiruvananthapuram

2.Kollam

3.Alappuzha

4.Adoor

5.Trichur

6.Kannur

InstituteofManagementinKerala
UniversityofKerala
UniversityCampus,Kariavattom,Thiruvananthapuram695581.

KUCAT2013
HallTicket

Affixastampsize
photo

NAMEOFTHECANDIDATE
REGISTERNUMBER*
DATEOFENTRANCE
EXAMINATION*
REPORTINGTIME*
EXAMINATIONCENTRE*

(*For Office Use Only)

SignatureoftheCandidate:

Instructionstocandidates:
1. Pleasereportattheexaminationcentre30minutesbeforethecommencementof
examination
2. HallticketsshouldbesubmittedtotheTestAdministratorforverification.
3. CandidatesarerequestedtouseonlyBlackBallpointpenforthetest.
4. Notes,Calculators,Cellphoneandotherelectronicdevicesarenotpermittedinthe
examinationhall.
5. Malpracticesofanysortarenotpermissible.

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