INDIAN I NSTI TUTE OF MANAGEMENT CALCUTTA

Post Graduate Diploma in Management (PGDM)

Post Graduate Diploma in Computer Aided Management (PGDCM)


Application Form for Personal I nterview (PI)/ Written Ability Test (WAT) 2014
Please tick ( ) the programme(s) you have been short-listed for:

PGDM PGDCM

CAT Registration No.:


1. Name: ________________________________________________________________________________
(In CAPITAL LETTERS, as recorded in your school leaving certificate)


Category ( ) : General SC ST DA
+
NC-OBC NC-OBC Minority

(I f NC-OBC, NC-OBC Minority, SC, ST or DA, attach necessary certificates)

If NC-OBC/NC-OBC Minority, mention name of the Castes/Sub-Castes/Communities

State Entry No.^ (Please follow:http://ncbc.nic.in/backward-classes/index.html)
Date of Birth
Marital Status ( ): Gender ( ): Nationality ( ):
Single Married Male Female Indian Others
DD MM YYYY
Name of the city you are appearing for I nterview

Present Mailing Address:

Pin code:
Landline No.: Mobile No.:
E-mail ID:

Permanent Address:

Pin code:
Landline No.: Mobile No.:
E-mail ID:

Guardians Name: _________________________________________________ Relationship: ______________

Fathers Name: _______________________________ Mothers Name: _______________________________

Education Occupation Designation Annual I ncome (Rs.)
Father

Mother


Annual I ncome of the Applicant*(Rs.): ________________________________ Financial Year: _____________

Annual I ncome of Family including the Applicant*(Rs.): ___________________ Financial Year: ____________
_________________________________________________________________________________________
+ Differently Abled
^ Central List of NC-OBC by the National Commission of Backward Classes, GoI as on last day of CAT 2013 registration will be used.
Any subsequent changes will not be effective for this year admission process. Please fill-in the Entry No. & Caste/Sub- Castes/
Communities Boxes above.
* Applicants income should include variable and fixed income if employed. Please ensure the validity of self and family income
statements as they may be subject to verification for internal administration.

R S


Please affix a
self attested
recent
passport size
photograph


ACADEMI C RECORD

1. Pre-Bachelor Degree Examination: (Bring self attested copies of the final mark-sheet/ certificates)

Stream during classes 11 12: ________________________________________________________________
Class
Name of the School / Board
& University
Year of
Passing
Total Maximum
Marks
Marks
Obtained
Percentage Division
10
th




12
th





(For computing percentages of marks obtained in SSC or equivalent and HSC or equivalent examination,
the aggregate marks of all subjects that appear in the mark sheet/ grade sheet would be considered)

2. Bachelors Degree Examination: (Bring self attested copies if completed)

A. Discipline ( ): Arts Commerce Engineering Science Others

If Others, please specify: _____________________________________________________________________

Specialization in Bachelors Degree: _____________________________________________________________

B. Bachelors Degree Examination Details: (Bring attested copies from Registrar/Principal/Director/Head of the
Institute if not completed)
If not completed, produce a certificate from the college/ institution certifying that you have obtained at least
50% marks or equivalent (45% in case of candidates belonging to SC, ST and DA category) based on the
latest available grade/ marks. The proforma of the certificate is enclosed.

Degree
Name of College/
Institute & University
Year Total Maximum
Marks/CGPA
Total Marks/
CGPA Obtained
Percentage Class
From To







Total


Expected date of completion of final examination including practical/viva/assignments/projects: _____________


3. Masters Degree Examination:

A. Discipline ( ): Arts Commerce Engineering Science Others

If Others, please specify: _____________________________________________________________________

Specialization in Masters Degree: ______________________________________________________________

B. Masters Degree Examination Details: (Bring self attested copies of all mark-sheets received so far)

Degree
Name of College/
Institute & University
Year Total Maximum
Marks/CGPA
Total Marks/
CGPA Obtained
Percentage Class
From To




Total


Expected date of completion of final examination including practical/viva/assignments/projects: _____________

4. Other Professional Degree/ Diploma (if completed): _______ _________ __________________






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Extra Curricular Activities in College/ University:

Nature of Activity Honours/ Award & Prizes, if any

















Extra Curricular Activities at District/ State/ National Level:

Nature of Activity Level* Honours/ Award & Prizes, if any




















* Mention District/ State/ National Level


List out your hobbies (not more than two) with brief description:


1.








2.










Career Goals: (Do not write more than 100 words):















Academic Distinctions/ Prizes/ Awards/ any other useful information:

Sl. No. Title Year
1

2

3

4

5


DECLARATION:

I declare that the information given by me in this application form is true and complete in all
respects to the best of my knowledge. I understand that suppression of facts or false
information may lead to rejection of my application at any stage of the selection process. I also
understand that the decision of II M Calcutta in any matter related to the selection process is
final and binding upon me.


___________________ ____ __________ ____________ ____ ___________________ _
Place Date Signature of Applicant



I I N N S S T T R R U U C C T T I I O O N N S S


1. This Application Form should be duly filled-in and must be handed over to the interview panel during
the interview.


2. The CAT 2013 Score Card must be produced for verification. You also need to bring at least
one acceptable form of photo-identification. Acceptable forms of valid photo identification
are valid Drivers license, Passport, PAN Card, Voter ID, Employee identification card, or a
notarized Affidavit with Photo, Signature, Date of Birth and Residential Address.


3. Please affix a self attested recent passport size photograph.

4. NC-OBC/SC/ST candidates are required to submit a certificate (proforma enclosed) duly signed by the
competent authority along with the application form. Candidates are also required to bring the original
certificate for verification at the time of interview. Only certificates issued by competent
authorities designated by the State/ UT/ Central Government will be considered.


5. Differently Abled (DA) candidates are required to submit a certificate (proforma enclosed) duly signed
by the competent authority as per the Persons with Disability (PWD) Act 1995. Candidates are also
required to bring the original certificate for verification at the time of interview.


6. Please ensure the correctness of the self and family income statements as they may be subject to
verification for internal administration.


7. All the original academic certificates/mark-sheets must be produced at the time of interview for
verification.

8. Please bring self attested copies of all mark-sheets and certificates. Candidates who have already
completed their graduation are advised to submit the self attested photocopies of their mark sheets,
degree and other certificates. Candidates who are pursuing their graduation or yet to complete their
Graduation/Post Graduation/Professional Qualification are advised to get their mark sheets attested
by the Registrar, Principal, Director or Head of the Department of the I nstitute.


9. Necessary evidence (Certified record of experience or first and last pay slips) in support of work
experience must be attached along with the application form and the original documents must be
produced at the time of interview. Please note that Appointment Letter will not be considered
as joining date in lieu of first salary slip. If evidence of work experience is not produced
during the interview, the work experience will be taken as NIL.


10. Necessary evidence must be produced in support of extra curricular activities at the time of interview.


11. Wherever letter/point grades are used, corresponding percentage equivalents should be provided. A
certificate from the relevant University/Institute must be enclosed indicating the conversion formula. If
such a conversion is not possible, mention it below the marks columns and enclose a certificate from
the relevant University/Institute to that effect.


12. This Application Form and proforma of certificates can also be downloaded from I IM Calcutta website
www.iimcal.ac.in.