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POSTGRADUATE INSTITUTE OF MANAGEMENT ALUMNI

APPLICATION FORM
PLATINUM HONOUR FOR PhD/MBA/MPA/MCA 2014
(PIMA MEMBERS ONLY)

Life Member No .....
01). Applicants details:
Name in full


Address


NIC No
Tele
Office
Residence
Fax
Mobile

E-Mail
Pre PIM
Masters
Profile


02). Business details:
Position in business
Name of the organization
Business industry
Type of the organization

03). Achievements: Academic / Professional:




Photograph

POSTGRADUATE INSTITUTE OF MANAGEMENT ALUMNI

04). Professional recognitions achieved (Post PIM Masters qualification):








05). Career progress post PIM Masters degree:











05 a). Your Contribution to your Organization/ Industry:
(e.g.: Balance score card profile Learning & Growth, customer, Financials, and Business Processes)
Note: Pls. obtain company CEO endorsement for each contribution










POSTGRADUATE INSTITUTE OF MANAGEMENT ALUMNI

05 b). Explain which of the above are the best in your opinion:











06). Your achievement through contribution to the society:
(e.g.: positions in social and non-profit organization, special activities introduced, initiated,
project chaired, responsibilities undertook and achievements)







07). International / Local recognitions achieved by you individually or through your organization
in the recent past (Post qualifying last 5 years):










POSTGRADUATE INSTITUTE OF MANAGEMENT ALUMNI

08). Participation with PIM/ PIMA (your contribution in past and present):







09). Present your personal SWOT analysis:
(Give at least five criteria in each, prioritized)











09 a). What is your personal plan, based on these SWOT:












POSTGRADUATE INSTITUTE OF MANAGEMENT ALUMNI

10). Your spiritual values (Personal, Family or Professional):







11). Any other relevant facts you would like to mention:










Applicants Signature:..
Date: ..

POSTGRADUATE INSTITUTE OF MANAGEMENT ALUMNI

RULES AND REGULATIONS

1. This opportunity is opened to all Masters Graduates of PIM.
2. The applicant should be a member of the PIMA or should obtain Life Membership from the
Association prior to the closing date.
3. Only the Applications issued by the PIMA secretariat are valid.
4. The members could either apply by themselves or be nominated by another member.
5. The applications will close on the 07
th
February 2014. Applications received after the
closing date will not be entertained.
6. The application should be recommended by two referees.
a) The CEO/ Director of the company/institution in which the applicant is attached.
b) A person with a similar status in a recognized government/private organization.

7. The decision of the Executive Committee of PIMA 2013/14 will be final.
8. The present Executive Committee members are not eligible to apply or be nominated.
9. All information furnished should be supported with documentary proof and signed by the
CEO.
10. The application should be typed.
11. Achievers Award winners applications will not be accepted since this is a renaming of the
same award.

I hereby agree to the above rules and regulations

Applicants Signature .. Date

Witness Name & Signature .. Date...



POSTGRADUATE INSTITUTE OF MANAGEMENT ALUMNI

First Referee
Name in Full:
Organization:
Designation:
Office Address:

Contact Numbers: a. Office .
b. Mobile .
c. Residence .

Signature . Date

Second Referee
Name in Full:
Organization:
Designation:
Office Address:

Contact Numbers: a. Office .
b. Mobile .
c. Residence .

Signature . Date

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