ABV-Indian Institute of Information Technology & Management, Gwalior

Morena Link Road, Gwalior, Madhya Pradesh, India - 474015

Admission Form For MBA – 2019-21
MBA (Business Analytics) Last Date: 04.02.2019
Personal Information: Application ID:
(Not to be filled by Candidate)

Full Name :

Father’s Name : Mother’s Name : Please paste a

Passport size photo
Date of Birth : Spouse Name :

Category : Middle Name :

Gender : Nationality :

Mobile No.: Alt. Mobile No.:

Email Id : Alt. Email Id:

Resident Of J&K: YES/NO Aadhar No:
Person with Disability : (YES/NO)

Correspondence Address:

Correspondence Address :

City/Village: State: Country: Pin:

Permanent Address:

Permanent Address :

City/Village: State: Country: Pin:

Payment Details:

DD No: Bank Name: Date: Amount:

Educational Details:

Qualification Passing Board/ College / School Max. Obt. Percentage Max Obt.
Year University Marks Marks (%) CGPA/ CGPA/C
CPI PI
th
High School (10 )

Higher
Secondary(10+2)

Graduation
(B.Tech/BE/others)

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 ABV-Indian Institute of Information Technology & Management, Gwalior
Morena Link Road, Gwalior, Madhya Pradesh, India - 474015
Others(M.Sc/MA/MCA
etc.) with maths as
essential subject
(Pl. mention)

Other Details
Choice of Examination Centre (as per the advertisement):

Applied for MBA Programme earlier: Yes / No Discipline: Applied Year:

CAT/MAT/CMAT/GMAT, Examination Details:

S.No. Exam Name Reg No/Roll No Overall Score Overall Percentile Qualifying

Work Experience:

S.No. Organization Designation Date from Date to Experience Gross Salary

Details of References: {Who works in Business Analytics/ Analytics Company (if any)}

S.No. Name Designation Email Id Mobile No.

Declaration by the Applicant

a) I hereby certify that foregoing particulars are correct and I agree that admission may be granted to me on the terms, conditions
and rules of the ABV-IIITM Gwalior or such modifications thereof as may be made by authorities concerned from time to time. I
understand that my admission may be cancelled and fee paid by me forfeited if any of the particulars given by me in this
application form are subsequently found to be wrong
b) I agree that the institute decision in all matters concerning my admission, studies discipline and conduct will be final and
binding to me.
c ) On admission , I undertake to submit myself to the disciplinary jurisdiction of the institute according to the rule of institute.
d) I understand that my association, active or passive, with any unlawful organization is forbidden.
e) I certify that I am not registered as provisional or otherwise student of any other institute. I understand that mere fulfilling
eligibility criteria does not entail me for admission to MBA programme(s).

Signature:

List of Documents to be attached: (please attach Photostat copy of the following documents with the form)

S.No. Document
1 High School (10th)
2 Higher Secondary (10+2)
3 Graduation – B-TECH
4 Other education qualification (if applicable)
5 Statement of Purpose
6 National Level Exam - CAT/MAT/CMAT/GMAT
7 Category Certificate (if applicable)
8 PwD certificate (if applicable)
9 J&K resident certificate (if applicable)
10 Original Demand Draft of the applicable amount as per the advertisement

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